Provider Demographics
NPI:1124417217
Name:GAWRON, SHANNON NICOLE (MSED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLE
Last Name:GAWRON
Suffix:
Gender:F
Credentials:MSED, CCC-SLP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:NICOLE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:461 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORTER CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12859-1919
Mailing Address - Country:US
Mailing Address - Phone:518-269-8852
Mailing Address - Fax:
Practice Address - Street 1:461 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PORTER CORNERS
Practice Address - State:NY
Practice Address - Zip Code:12859-1919
Practice Address - Country:US
Practice Address - Phone:518-269-8852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025297235Z00000X
CT5811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist