| Doctor Name: | MRS. SHANNEN DOROTHEA UTLEY |
| NPI Number: | 1053683995 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA CCC-SLP |
| License Number: | 102409 |
| Business Practice Address: | 12345 Jones Rd Suite 215 Houston, TX - 770704855 |
| Business Phone Number: | 8326637541 |
| Business Fax Number: | 8327172808 |
| Mailing Address: | 12345 Jones Rd, Suite 215 HOUSTON |
| State: | TX |
| Postal Code: | 770704855 |
| Phone Number: | 8326637541 |
| Fax Number: | 8327172808 |
| NPI Enumeration Date: | 02/08/2012 |
| NPI Last Update Date: | 09/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 102409 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |