Most Relevant Information
Provider Data
| NPI Number: | 1003308693 |
| Provider Name: | SHANNON AMBER KALLSEN M.S. |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 114495 |
Most Important Dates
| Enumeration Date: | 05/31/2018 |
| Last Updated: | 05/31/2018 |
Provider Practice Location
15820 ADDISON RD
ADDISON
TX
750013549
Practice Location Phone/Fax
| Phone: | 8669193240 |
| Fax: |
Provider Mailing Location
4409 TRAVIS ST APT C
DALLAS
TX
752054117
Provider Mailing Phone/Fax
| Phone: | 5053855571 |
| Fax: |