Individual
MRS. SHANNON MARIE TYLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
960 DURHAM WAY, STOCKBRIDGE, GA 30281-7950
(404) 395-4578
(404) 920-3396
Mailing address
960 DURHAM WAY, STOCKBRIDGE, GA 30281-7950
(404) 395-4578
(404) 920-3396
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP004924
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000891943E
—
GA
05
—
000891943G
—
GA
05
—
000891943H
—
GA
Enumeration date
08/19/2005
Last updated
01/15/2014
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