Individual
SHANNON LAURA DALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MACCCSLP
Contact information
Practice address
17679 W TASHA DR, SURPRISE, AZ 85388-1770
(623) 262-0092
Mailing address
17679 W TASHA DR, SURPRISE, AZ 85388-1770
(623) 262-0092
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP5074
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123566
SPEECH LANGUAGE PATHOLOGI
AZ
Enumeration date
02/22/2007
Last updated
04/26/2017
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