Individual
SHANNON ELLIS HANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
1626 PACES COMMONS DR, DULUTH, GA 30096-1727
(043) 371-4064
(855) 232-8604
Mailing address
1626 PACES COMMONS DR, DULUTH, GA 30096-1727
(043) 371-4064
(855) 232-8604
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
105149
TX
235Z00000X
Speech-Language Pathologist
Primary
SLP006477
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031DG
BLUE CROSS BLUE SHIELD
—
05
—
0944746-02
—
TX
01
—
74-2745294
TAX ID
—
Enumeration date
07/29/2010
Last updated
09/03/2020
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