Healthcare Provider Details

I. General information

NPI: 1588577027
Provider Name (Legal Business Name): SHANNON M. AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 NARCISSUS DR
EAST LANSING MI
48823-5135
US

IV. Provider business mailing address

2662 COREOPSIS DR
OKEMOS MI
48864-3363
US

V. Phone/Fax

Practice location:
  • Phone: 517-333-5060
  • Fax:
Mailing address:
  • Phone: 517-333-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101000391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: