MEDICARE: SHANNON WARD

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	1884	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1884	OTHER	CO	SLP LICENSE#

General Provider Information

NPI Number	:	1417401290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON WARD

Provider Business Mailing Address
First Line	:	535 E MISSISSIPPI AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-1608
Country	:	US
Telephone Number	:	303-777-5580
Fax Number	:	303-552-2064

Provider Business Practice Location Address
First Line	:	535 E MISSISSIPPI AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-1608
Country	:	US
Telephone Number	:	303-777-5580
Fax Number	:	303-552-2064

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

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	08/09/2016

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Directions to “ SHANNON WARD ” Practice Location

Language	Start Address	Practice Location

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