Provider Demographics
NPI:1699077941
Name:ATKINSON, SHANNON ROSE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ROSE
Last Name:ATKINSON
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 1:970 TARA OAKS CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7027
Mailing Address - Country:US
Mailing Address - Phone:609-923-0469
Mailing Address - Fax:
Practice Address - Street 1:11500 CRONRIDGE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2261
Practice Address - Country:US
Practice Address - Phone:410-531-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist