Individual provider Active NPI

Shannon Marie Tyler, MS CCC-SLP

  • Speech-Language Pathologist
  • Stockbridge, GA
National Provider Identifier
1710979281
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP004924 Issued in GA
Practice address
960 Durham Way
Stockbridge, GA 30281-7950
Phone
(404) 395-4578
Fax
(404) 920-3396
NPI assigned
Aug 19, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP004924 GA Primary

Addresses

Primary practice location

960 Durham Way
Stockbridge, GA 30281-7950

Mailing address

960 Durham Way
Stockbridge, GA 30281-7950
Phone (404) 395-4578

Other practice location 1

9150 Peridot Pkwy
Stockbridge, GA 30281-9400
Phone (470) 694-5346

Other identifiers 3

IdentifierTypeStateIssuer
000891943GMedicaidGA
000891943HMedicaidGA
000891943EMedicaidGA

Other names 1

  • Shannon Kirkpatrick Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
SLP004924GAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Tiny Talkers Therapy Services, Inc. Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788393600000",
    "number": "1710979281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 DURHAM WAY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817950",
            "telephone_number": "404-395-4578",
            "fax_number": "404-920-3396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 DURHAM WAY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817950",
            "telephone_number": "404-395-4578",
            "fax_number": "404-920-3396"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9150 Peridot Pkwy",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302819400",
            "country_code": "US",
            "telephone_number": "470-694-5346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TYLER",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MS CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-19",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP004924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000891943G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000891943H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000891943E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "KIRKPATRICK",
            "credential": "MS CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; 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.