Doctor Name: | MRS. SHANNON MARIE TYLER |
NPI Number: | 1710979281 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCC-SLP |
License Number: | SLP004924 |
Business Practice Address: | 960 Durham Way Stockbridge, GA - 302817950 |
Business Phone Number: | 4043954578 |
Business Fax Number: | 4049203396 |
Mailing Address: | 960 Durham Way, STOCKBRIDGE |
State: | GA |
Postal Code: | 302817950 |
Phone Number: | 4043954578 |
Fax Number: | 4049203396 |
NPI Enumeration Date: | 08/19/2005 |
NPI Last Update Date: | 01/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP004924 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
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 |