Provider Demographics
NPI:1679599641
Name:SIMPSON, SHANNON JEANNE (MCDCCCSLP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:JEANNE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MCDCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 COUNTY ROAD 766
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6982
Mailing Address - Country:US
Mailing Address - Phone:870-268-8448
Mailing Address - Fax:870-268-8448
Practice Address - Street 1:2350 COUNTY ROAD 766
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6982
Practice Address - Country:US
Practice Address - Phone:870-268-8448
Practice Address - Fax:870-268-8448
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP # 1874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSP #1874OtherSTATE LICENSURE NUMBER