Provider Demographics
NPI:1336299940
Name:MCCANN, SHANNON ELLEN (SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELLEN
Last Name:MCCANN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2812
Mailing Address - Country:US
Mailing Address - Phone:603-882-6333
Mailing Address - Fax:603-889-5460
Practice Address - Street 1:144 CANAL ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2812
Practice Address - Country:US
Practice Address - Phone:603-882-6333
Practice Address - Fax:603-889-5460
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH626514OtherCOMMON TAX ID
NH272740OtherCIGNA
NH561822OtherAETNA
NH99560056Medicaid
NH626514OtherHARVARD PILGRIM
NH761242OtherTUFTS