Shannon Roden, M.ED., SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

218163 Issued in OK

Practice address

1604 S Seminole Ave
Wewoka, OK 74884-3923

Phone

(918) 413-9710

NPI assigned

Feb 6, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486339200000",
    "number": "1063950475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1831 AIRPORT DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748042640",
            "telephone_number": "405-273-3388",
            "fax_number": "405-273-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 S SEMINOLE AVE",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748843923",
            "telephone_number": "918-413-9710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODEN",
        "first_name": "SHANNON",
        "credential": "M.ED., SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-06",
        "last_updated": "2017-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "218163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATION FOR SPEECH LANGUAGE PATHOLOGY IN THE SCHOOL",
            "identifier": "218163",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kymberli Ogle
• Peak Medical Oklahoma No. 11, Inc.
• Wendy J Pingleton, APRN
• Andrea Nicole Polson, RN
• Troy Ray
• Saints Medical Group, LLC
• Jennifer Sharma, RN
• John R Smith, DDS
• Misty Smith
• Susan D Sollars

• Speech-Language Pathologist in Wewoka, OK
• Providers in Wewoka, OK by specialty
• Speech-Language Pathologist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.