=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669768669
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON FILIPPONI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2011
-----------------------------------------------------
Last Update Date | 11/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 811 W EVERGREEN AVE SUITE 404
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60642-2682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-975-3928
-----------------------------------------------------
Fax | 888-972-7531
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 811 W EVERGREEN AVE SUITE 404
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60642-2682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-975-3928
-----------------------------------------------------
Fax | 888-972-7531
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SZ5381
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA11709
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 146.013473
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------