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General NPI Number Information
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NPI Number | 1619728037
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Entity Type | Individual
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Provider Name | SHANNON RAE SHAFFER MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 633 LIBRARY PARK DR STE J
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City | GREENWOOD
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State | IN
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Zip | 46142-1578
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Country | US
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Telephone | 317-881-9923
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Fax |
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Provider Business Mailing Address
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Address Line | 3778 W 380 S
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City | NEW PALESTINE
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State | IN
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Zip | 46163-9160
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Country | US
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Telephone | 317-550-7399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 14337051
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License Number State | IN
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