1114416401 NPI number — SHANNON MICHELLE COYLE MA-ED, CCC-SLP

Table of content: SHANNON MICHELLE COYLE MA-ED, CCC-SLP (NPI 1114416401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114416401 NPI number — SHANNON MICHELLE COYLE MA-ED, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COYLE
Provider First Name:
SHANNON
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA-ED, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEECH
Provider Other First Name:
SHANNON
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA-ED, CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114416401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
343 SPRINGHILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40422-1041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-516-8676
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ASCB THERAPY
Provider Second Line Business Practice Location Address:
4603 TIMBER WALK CT.
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-864-6695
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)