Shannon Forman, 4188

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4188 Issued in SC

Practice address

100 Blassingame Rd
Greenville, SC 29605-3304

Phone

(864) 355-3100

Fax

(864) 355-9828

NPI assigned

Nov 29, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Greenville County School District

  • Local Education Agency (LEA)
  • Greenville, SC
  • NPI 1861211658
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370304000000",
    "number": "1508933383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BLASSINGAME RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296053304",
            "telephone_number": "864-355-3100",
            "fax_number": "864-355-9828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BLASSINGAME RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296053304",
            "telephone_number": "864-355-3100",
            "fax_number": "864-355-9828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMAN",
        "first_name": "SHANNON",
        "name_prefix": "Mrs.",
        "credential": "4188",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2013-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA3471",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "4188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "884220500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cameron Fordham, BSN, RN
• Forensic Counseling Associates, Professional Corporation
• William Alexander Forgach II, D.O.
• Lisa Marie Forgione
• Form X Function Wellness, LLC
• Lisa Dandridge Forrester, MD
• Ryan Taylor Forrester, M.D.
• Simon Blaine Forrester, CRNA
• Carl Gunnar Forsberg, M.D.
• David Andrew Forstein, D.O.

• Speech-Language Pathologist in Greenville, SC
• Providers in Greenville, SC by specialty
• Speech-Language Pathologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2013; 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.