MEDICARE: MRS. SHANNON MCCANTS MCELROY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1427447267	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1023285905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON MCCANTS MCELROY

Provider Business Mailing Address
First Line	:	1040 N WALNUT AVE STE A
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-5317
Country	:	US
Telephone Number	:	830-214-0866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 N WALNUT AVE STE A
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-5317
Country	:	US
Telephone Number	:	830-214-0866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2008
Last Update Date	:	09/29/2015

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