Provider Demographics
NPI:1194099267
Name:DINGER, SHANNAN NICOLE (HIS)
Entity type:Individual
Prefix:
First Name:SHANNAN
Middle Name:NICOLE
Last Name:DINGER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 OLDE STONE XING
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4202
Mailing Address - Country:US
Mailing Address - Phone:330-787-7865
Mailing Address - Fax:888-516-1186
Practice Address - Street 1:6400 OLDE STONE XING
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-4202
Practice Address - Country:US
Practice Address - Phone:330-787-7865
Practice Address - Fax:888-516-1186
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3071237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist