Healthcare Provider Details

I. General information

NPI: 1174654792
Provider Name (Legal Business Name): SHANNON QUIN SCHAFFLER M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON RENEE QUIN M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9441 LYNDON B JOHNSON FWY SUITE 101
DALLAS TX
75243-4545
US

IV. Provider business mailing address

7343 MIMOSA LN
DALLAS TX
75230-5445
US

V. Phone/Fax

Practice location:
  • Phone: 214-575-9820
  • Fax:
Mailing address:
  • Phone: 214-460-6199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number101270
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: