Active NPI
Shannon Grace Carroll, CF-SLP
- Speech-Language Pathologist
- Albuquerque, NM
National Provider Identifier
1740639376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- C-5967
- Practice address
- 12908 Kachina PL NE Apt C
Albuquerque, NM 87112-3706 - Phone
- (505) 610-0841
- NPI assigned
- Jun 4, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 | C-5967 | NM | Primary |
Addresses
Primary practice location
12908 Kachina PL NE Apt C
Albuquerque, NM 87112-3706
Mailing address
12908 Kachina PL NE Apt C
Albuquerque, NM 87112-3706
Phone (505) 610-0841
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-5967 | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468195200000",
"number": "1740639376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12908 KACHINA PL NE APT C",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871123706",
"telephone_number": "505-610-0841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12908 KACHINA PL NE APT C",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871123706",
"telephone_number": "505-610-0841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "SHANNON",
"middle_name": "GRACE",
"credential": "CF-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-04",
"last_updated": "2016-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "C-5967",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.