Shannon Spencer
Individual provider Active NPI Speech-Language Pathologist · Locke, NY
NPI 1245843069 · NPPES record last updated Aug 26, 2026
Key facts
- NPI
- 1245843069
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 036456 (NY)
- Practice address
- 4688 Maple Ave
Locke, NY 13092-4191 - Phone
- (607) 423-0088
- NPI assigned
- Aug 31, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TL-3432 | NJ | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 036456 | NY | Yes |
Addresses
Primary practice location
4688 Maple Ave
Locke, NY 13092-4191
Mailing address
4688 Maple Ave
Locke, NY 13092-4191
Phone (607) 423-0088
Other providers in Locke, NY
- Cassie Wagner Crum
- Shawn R Dillon
- Sandra Kathleen Hammon
- Virginia K Neuschwander
- Rebekah Dawn Nickerson
- Janice Lea Wright
- Emily Joy Zieba
All providers in Locke, NY · Speech-Language Pathologist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.