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General NPI Number Information
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NPI Number | 1336369503
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Entity Type | Individual
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Provider Name | SHANNA CAMILLE KETRON AU.D., CCC-A, FAAA
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Gender | Female
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 343 W HOUSTON ST SUITE 409
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2107
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Country | US
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Telephone | 210-226-9166
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Fax | 210-226-9168
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Provider Business Mailing Address
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Address Line | 343 W HOUSTON ST
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2107
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Country | US
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Telephone | 210-226-9166
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 60512
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License Number State | TX
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