Basic Information
| Provider Information | |||||||||
| NPI: | 1942330857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHNELLER | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | NBC. HIS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NORMAN | ||||||||
| OtherFirstName: | SHANNON | ||||||||
| OtherMiddleName: | KAY | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | I | ||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6700 WASHINGTON AVE S | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553443405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123511529 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6318 NW BARRY RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641542531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165841074 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 2002012679 | MO | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | 1121 | KS | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237600000X | 1121 | KS | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.