1306061619 NPI number — MRS. SHANNON MARIE HARMON M.A. CCC-SLP

Table of content: MRS. SHANNON MARIE HARMON M.A. CCC-SLP (NPI 1306061619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306061619 NPI number — MRS. SHANNON MARIE HARMON M.A. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARMON
Provider First Name:
SHANNON
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A. 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:
SOWLE
Provider Other First Name:
SHANNON
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306061619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 GREENPOINT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12303-4103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-396-7669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 KROSS KEYS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12205-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-438-4800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2007

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 , with the licence number:  015329 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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