Provider Demographics
NPI:1679378798
Name:SHANNON L SERVANCE SPEECH THERAPY
Entity type:Organization
Organization Name:SHANNON L SERVANCE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SERVANCE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:713-545-0349
Mailing Address - Street 1:3154 BONNEY BRIAR DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3113
Mailing Address - Country:US
Mailing Address - Phone:713-545-0349
Mailing Address - Fax:
Practice Address - Street 1:3154 BONNEY BRIAR DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3113
Practice Address - Country:US
Practice Address - Phone:713-545-0349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty