Individual
SHANNON CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7719 224TH ST E, GRAHAM, WA 98338-7361
(253) 683-8800
Mailing address
9907 130TH STREET CT E, APT J210, PUYALLUP, WA 98373-9426
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL 60312193
WA
Other
Enumeration date
11/07/2012
Last updated
11/07/2012
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