Healthcare Provider Details

I. General information

NPI: 1427284777
Provider Name (Legal Business Name): SHAYNA R DOERR M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 STATE AVE STE B
DICKINSON ND
58601-4660
US

IV. Provider business mailing address

683 STATE AVE STE B
DICKINSON ND
58601-4660
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-9400
  • Fax:
Mailing address:
  • Phone: 701-483-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1075
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: