Provider Demographics
NPI:1174869390
Name:BAKER, SHANNON (MS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11119 W 114TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3409
Mailing Address - Country:US
Mailing Address - Phone:217-242-2050
Mailing Address - Fax:
Practice Address - Street 1:11119 W 114TH TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-3409
Practice Address - Country:US
Practice Address - Phone:217-242-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-15
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024045402237700000X
MO2012015945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist