Doctor Name: | SHANNON ELYSE BOTHWELL |
NPI Number: | 1205215407 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. SLP-CFY |
License Number: | 46002739A |
Business Practice Address: | 6239 S East St Ste A Indianapolis, IN - 462272088 |
Business Phone Number: | 3174424734 |
Business Fax Number: | |
Mailing Address: | 11236 N Us Highway 231, ODON |
State: | IN |
Postal Code: | 475625602 |
Phone Number: | 8124868596 |
Fax Number: | |
NPI Enumeration Date: | 05/21/2015 |
NPI Last Update Date: | 05/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 46002739A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
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 |