| Doctor Name: | MRS. TAMARA MAUREEN SHANNON |
| NPI Number: | 1164513792 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS CCC SLP |
| License Number: | 7993 |
| Business Practice Address: | 900 W 94th St Bloomington, MN - 55420 |
| Business Phone Number: | 9528850418 |
| Business Fax Number: | 9528850173 |
| Mailing Address: | 6972 Ashwood Road, Apt 307 WOODBURY |
| State: | MN |
| Postal Code: | 55125 |
| Phone Number: | 6517353709 |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 7993 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| 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 |