Individual
SHANNON CORMIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
4403 MALLARD LANE, CONWAY, AR 72034
(501) 804-8770
Mailing address
4403 MALLARD LANE, CONWAY, AR 72034
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
12027998
—
235Z00000X
Speech-Language Pathologist
Primary
SP#1908
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5X227
BLUE CROSS BLUE SHIELD
AR
Enumeration date
10/02/2006
Last updated
07/09/2007
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