Individual
SHANNON GRACE CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CF-SLP
Contact information
Practice address
12908 KACHINA PL NE APT C, ALBUQUERQUE, NM 87112-3706
(505) 610-0841
Mailing address
12908 KACHINA PL NE APT C, ALBUQUERQUE, NM 87112-3706
(505) 610-0841
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
C-5967
NM
Other
Enumeration date
06/04/2016
Last updated
07/11/2016
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