Provider Demographics
NPI:1104278779
Name:DUNBAR, SHANNON HADDAD (MA/CCC-SLP, CDP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:HADDAD
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:MA/CCC-SLP, CDP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:HADDAD
Other - Last Name:DEEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA/CCC-SLP, CDP
Mailing Address - Street 1:4851 TINCHER RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-3780
Mailing Address - Country:US
Mailing Address - Phone:317-856-4851
Mailing Address - Fax:
Practice Address - Street 1:4851 TINCHER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-3780
Practice Address - Country:US
Practice Address - Phone:317-856-4851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004562A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist