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General NPI Number Information
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NPI Number | 1689174005
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Entity Type | Individual
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Provider Name | JOANNA SHORES MS CCC SLP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 6125 E BELKNAP ST
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City | HALTOM CITY
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State | TX
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Zip | 76117-4204
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Country | US
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Telephone | 817-547-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 5604 DAVIS BLVD
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180
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Country | US
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Telephone |
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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 | 100775
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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