Healthcare Provider Details

I. General information

NPI: 1285567149
Provider Name (Legal Business Name): SHAWNEE MICHELLE RYAN CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 FAIRVIEW RD
LITTLE ROCK AR
72212-2406
US

IV. Provider business mailing address

1059 SKYLINE DR
ALEXANDER AR
72002-1749
US

V. Phone/Fax

Practice location:
  • Phone: 502-227-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: