Provider Demographics
NPI:1386795086
Name:SCHOOLER, SHANNON LYNNETTE (MC, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:LYNNETTE
Last Name:SCHOOLER
Suffix:
Gender:F
Credentials:MC, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 CENTRAL SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7113
Mailing Address - Country:US
Mailing Address - Phone:636-851-5700
Mailing Address - Fax:
Practice Address - Street 1:4525 CENTRAL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-7113
Practice Address - Country:US
Practice Address - Phone:636-851-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004017648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist