Individual
SHANNON WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(800) 528-8989
Mailing address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8000
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
7101001306
MI
235Z00000X
Speech-Language Pathologist
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7101001306
LARA (MICHIGAN)
MI
Enumeration date
07/02/2022
Last updated
07/02/2022
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