Healthcare Provider Details

I. General information

NPI: 1942795810
Provider Name (Legal Business Name): SHANNON EVANS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2018
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W ELK AVE
DUNCAN OK
73533-1827
US

IV. Provider business mailing address

2150 W ELK AVE
DUNCAN OK
73533-1827
US

V. Phone/Fax

Practice location:
  • Phone: 580-251-8460
  • Fax: 580-251-6654
Mailing address:
  • Phone: 580-251-8460
  • Fax: 580-251-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number120063
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5234
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number114555
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: