Provider Demographics
NPI:1538783733
Name:WHITTLEY, SHANNON ELIZABETH CAMPBELL
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELIZABETH CAMPBELL
Last Name:WHITTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ELIZABETH
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1133 E WEST HWY APT 1417W
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-6834
Mailing Address - Country:US
Mailing Address - Phone:508-364-4892
Mailing Address - Fax:
Practice Address - Street 1:1133 E WEST HWY APT 1417W
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-6834
Practice Address - Country:US
Practice Address - Phone:508-364-4892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD235Z00000X
MA77632235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist