1811201106 NPI number — SHANNON ELLIS HANES M.S. CCC-SLP

NPI Number: 1811201106
Health Care Provider/Practitioner: SHANNON ELLIS HANES M.S. CCC-SLP

NPI Number : 1811201106 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811201106",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HANES",
    "FirstName": "SHANNON",
    "MiddleName": "ELLIS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S. CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1626 PACES COMMONS DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DULUTH",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30096-1727",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "43-371-4064",
    "MailingAddressFaxNumber": "855-232-8604",
    "FirstLinePracticeLocationAddress": "1626 PACES COMMONS DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DULUTH",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30096-1727",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "43-371-4064",
    "PracticeLocationAddressFaxNumber": "855-232-8604",
    "EnumerationDate": "07/29/2010",
    "LastUpdateDate": "09/03/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "105149",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "SLP006477",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}