Active NPI
Shannon Zimmerman, CCC-SLP
- Speech-Language Pathologist
- Woodbury, MN
National Provider Identifier
1336596626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 9483
- Practice address
- 2101 Wooddale Dr Ste a
Woodbury, MN 55125-2933 - Phone
- (651) 738-9888
- Fax
- (651) 738-9889
- NPI assigned
- May 17, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 9483 | MN | Primary |
Addresses
Primary practice location
2101 Wooddale Dr Ste a
Woodbury, MN 55125-2933
Mailing address
2101 Wooddale Dr Ste a
Woodbury, MN 55125-2933
Phone (651) 738-9888
Other practice location 1
2835 W Saint Germain St
suite 300
Saint Cloud, MN 56301-6280
Phone (320) 259-4151
Other names 1
- Shannon Rudesill
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9483 | MN | MD | Orthopedic Physical Therapist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Occupational Therapist
- Woodbury, MN
- NPI 1952411175
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1463443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1336596626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 WOODDALE DR STE A",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252933",
"telephone_number": "651-738-9888",
"fax_number": "651-738-9889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 WOODDALE DR STE A",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252933",
"telephone_number": "651-738-9888",
"fax_number": "651-738-9889"
}
],
"practiceLocations": [
{
"address_1": "2835 W Saint Germain St",
"address_2": "suite 300",
"address_purpose": "LOCATION",
"city": "Saint Cloud",
"state": "MN",
"postal_code": "563016280",
"country_code": "US",
"telephone_number": "320-259-4151",
"fax_number": "320-259-5707",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ZIMMERMAN",
"first_name": "SHANNON",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-17",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "9483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "RUDESILL",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.