Basic Information
| Provider Information | |||||||||
| NPI: | 1881735801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCAVARELLI | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 E MINE CREEK RD | ||||||||
| Address2: | 1161 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850246256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802668777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2725 E MINE CREEK RD | ||||||||
| Address2: | 1161 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850246256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805027726 | ||||||||
| FaxNumber: | 4805134628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2007 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP4473 | AZ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.