Individual
SHANNON MARIE TYLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28 N HERITAGE WOODS LN, WINTHROP, ME 04364-3240
(207) 377-2472
(207) 377-2472
Mailing address
69 CONY RD, AUGUSTA, ME 04330-0500
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SAS1421
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266450099
—
ME
Enumeration date
12/22/2009
Last updated
12/22/2009
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