Provider Demographics
NPI:1831332808
Name:LOCKE, SHANNON L (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:LOCKE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:L
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:504 N GASCONADE CT
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8134
Mailing Address - Country:US
Mailing Address - Phone:417-818-0735
Mailing Address - Fax:
Practice Address - Street 1:504 N GASCONADE CT
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8134
Practice Address - Country:US
Practice Address - Phone:417-818-0735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000152074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist