Provider Demographics
NPI:1427314541
Name:SHANNON, ERIN BLUM (MS/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:BLUM
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 TRAILS END
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1310
Mailing Address - Country:US
Mailing Address - Phone:845-708-5174
Mailing Address - Fax:
Practice Address - Street 1:700 ASHFORD AVE
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2406
Practice Address - Country:US
Practice Address - Phone:914-693-7564
Practice Address - Fax:914-693-7896
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist