Provider Demographics
NPI:1871997254
Name:DEER, SHANNON (SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:DEER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S COTTINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:COYLE
Mailing Address - State:OK
Mailing Address - Zip Code:73027-9465
Mailing Address - Country:US
Mailing Address - Phone:405-466-2242
Mailing Address - Fax:
Practice Address - Street 1:700 S COTTINGHAM AVE
Practice Address - Street 2:
Practice Address - City:COYLE
Practice Address - State:OK
Practice Address - Zip Code:73027-9465
Practice Address - Country:US
Practice Address - Phone:405-466-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist