Provider Demographics
NPI:1104954411
Name:SCHIEDER, SHANNON BURCHETT (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:BURCHETT
Last Name:SCHIEDER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 FLINT POINT LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-6813
Mailing Address - Country:US
Mailing Address - Phone:919-567-8224
Mailing Address - Fax:919-552-0861
Practice Address - Street 1:360 RALEIGH STREET
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540
Practice Address - Country:US
Practice Address - Phone:919-342-5754
Practice Address - Fax:919-552-0861
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411600Medicaid
NC126AYOtherBLUE CROSS BLUE SHIELD
NC018CVOtherBLUE CROSS BLUE SHIELD
NC7212036Medicaid