Provider Demographics
NPI:1114416401
Name:COYLE, SHANNON MICHELLE (MA-ED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
Last Name:COYLE
Suffix:
Gender:F
Credentials:MA-ED, CCC-SLP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MICHELLE
Other - Last Name:LEECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-ED, CCC-SLP
Mailing Address - Street 1:343 SPRINGHILL RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1041
Mailing Address - Country:US
Mailing Address - Phone:859-516-8676
Mailing Address - Fax:
Practice Address - Street 1:ASCB THERAPY
Practice Address - Street 2:4603 TIMBER WALK CT.
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031
Practice Address - Country:US
Practice Address - Phone:703-864-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist