Provider Demographics
NPI:1982118733
Name:SMITH, SHANNON C (MS, SLP/CF)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, SLP/CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10566
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5010
Mailing Address - Country:US
Mailing Address - Phone:434-799-7732
Mailing Address - Fax:434-799-7733
Practice Address - Street 1:625 PINEY FOREST RD STE 407
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2870
Practice Address - Country:US
Practice Address - Phone:434-799-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist