Provider Demographics
NPI:1861538746
Name:DOWDLE, SHANNON P (MS CCCA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:P
Last Name:DOWDLE
Suffix:
Gender:F
Credentials:MS CCCA
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:K
Other - Last Name:PHINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:347 MAIN ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1338
Mailing Address - Country:US
Mailing Address - Phone:207-839-8400
Mailing Address - Fax:866-596-0877
Practice Address - Street 1:347 MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1338
Practice Address - Country:US
Practice Address - Phone:207-839-8400
Practice Address - Fax:866-596-0877
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP1233231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098737OtherANTHEM BCBS
ME264240099Medicaid