Healthcare Provider Details

I. General information

NPI: 1225963697
Provider Name (Legal Business Name): JEANETTE LOUISE SHUSTER M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1864 AMIS AVE
LAS CRUCES NM
88005-1652
US

IV. Provider business mailing address

1864 AMIS AVE
LAS CRUCES NM
88005-1652
US

V. Phone/Fax

Practice location:
  • Phone: 575-642-1889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2024-0150
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP17167
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: