Provider Demographics
NPI:1902550874
Name:O'ROURKE, SHANNON (AUD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4201
Mailing Address - Country:US
Mailing Address - Phone:860-529-3443
Mailing Address - Fax:860-513-1277
Practice Address - Street 1:919 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4201
Practice Address - Country:US
Practice Address - Phone:860-529-3443
Practice Address - Fax:860-513-1277
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4866231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist