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General NPI Number Information
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NPI Number | 1033447784
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Entity Type | Individual
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Provider Name | JOHNNA SHAIN MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 10/16/2022
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Provider Practice Location Address
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Address Line | 207 SW 6TH ST
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City | SEMINOLE
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State | TX
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Zip | 79360-4305
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Country | US
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Telephone | 432-758-1060
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Fax |
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Provider Business Mailing Address
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Address Line | 2107 NW AVENUE D
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City | SEMINOLE
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State | TX
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Zip | 79360-3007
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Country | US
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Telephone | 806-787-6441
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 105839
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License Number State | TX
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