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General NPI Number Information
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NPI Number | 1962785337
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Entity Type | Individual
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Provider Name | SHANNON KATHLEEN PERRY M.S ED CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 16165 LEARNING LN
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City | NAPLES
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State | FL
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Zip | 34110
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Country | US
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Telephone | 239-377-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 4141 SAWGRASS POINT DR
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-2928
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Country | US
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Telephone | 315-651-2866
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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 | 021415-1
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License Number State | NY
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