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General NPI Number Information
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NPI Number | 1396243119
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Entity Type | Organization
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Legal Business Name | SHANER SPEECH PATHOLOGY
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 771 E SOUTHLAKE BLVD STE 104
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6354
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Country | US
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Telephone | 714-393-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 771 E SOUTHLAKE BLVD STE 104
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6354
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Country | US
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Telephone | 714-393-0400
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR
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Name | MRS. AMY D SHANER
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Credential | MS, CCC-SLP
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Telephone | 714-393-0400
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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 | 114170
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License Number State | TX
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