Provider Demographics
NPI:1467799189
Name:SHANNON, MARY RACHAEL (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:RACHAEL
Last Name:SHANNON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9730 3RD AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2023
Mailing Address - Country:US
Mailing Address - Phone:206-367-1345
Mailing Address - Fax:206-367-1366
Practice Address - Street 1:5775 SOUNDVIEW DR STE C204
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2212
Practice Address - Country:US
Practice Address - Phone:253-514-8224
Practice Address - Fax:253-514-8273
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001070237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter