MEDICARE: SHANNEL PICKENS MS, CCC-SLP

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	108662	TX

General Provider Information

NPI Number	:	1669640603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNEL PICKENS MS, CCC-SLP

Provider Business Mailing Address
First Line	:	3118 NUTMEG LN
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75044-6172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 BREEZEWOOD AVE STE 101
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5283
Country	:	US
Telephone Number	:	910-484-1711
Fax Number	:

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

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	05/12/2022

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Directions to “ SHANNEL PICKENS MS, CCC-SLP” Practice Location

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