Healthcare Provider Details

I. General information

NPI: 1992787097
Provider Name (Legal Business Name): SHANON RADLEY KUSCH MS CCCA FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 W ROCK CREEK RD
NORMAN OK
73072-2202
US

IV. Provider business mailing address

1272 GARRISON DR
MURFREESBORO TN
37129-2570
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-2684
  • Fax: 405-364-1802
Mailing address:
  • Phone: 615-895-8440
  • Fax: 615-895-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA1364
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: