| Doctor Name: | MRS. SHANNON LEE JETT BERRY |
| NPI Number: | 1922141555 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, CCC-SLP |
| License Number: | SA6623 |
| Business Practice Address: | 218 N Florida St Suite 3 Bushnell, FL - 335136150 |
| Business Phone Number: | 3527934512 |
| Business Fax Number: | 3527934519 |
| Mailing Address: | 1586 County Road 543a, SUMTERVILLE |
| State: | FL |
| Postal Code: | 335855125 |
| Phone Number: | 3525680506 |
| Fax Number: | |
| NPI Enumeration Date: | 02/14/2007 |
| NPI Last Update Date: | 04/30/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA6623 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| 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 |