=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811950991
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHENA LAUGHLAND WILEMAN MARTIN M.A.,C.C.C.-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2006
-----------------------------------------------------
Last Update Date | 07/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1351 E SPRUCE AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-3342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-256-0200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3021 MAGNOLIA AVE
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93611-6016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-287-0690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AU380
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------