MEDICARE: SHAUNA LYNN REISER B.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLPL4663	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871615930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNA LYNN REISER B.A.

Provider Business Mailing Address
First Line	:	3819 E CAMELBACK RD APT 287
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2651
Country	:	US
Telephone Number	:	602-314-5398
Fax Number	:

Provider Business Practice Location Address
First Line	:	3819 E CAMELBACK RD APT 287
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2651
Country	:	US
Telephone Number	:	602-314-5398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/09/2007

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