MEDICARE: MS. JANE SHOOK MS CCC SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	12810	TX

General Provider Information

NPI Number	:	1164630554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE SHOOK MS CCC SLP

Provider Business Mailing Address
First Line	:	6330 LYNDON B JOHNSON FWY STE 137
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6425
Country	:	US
Telephone Number	:	972-233-9019
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 LYNDON B JOHNSON FWY
Second Line	:	SUITE 136
City	:	DALLAS
State	:	TX
Zip	:	75240-6467
Country	:	US
Telephone Number	:	972-233-9019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	02/08/2024

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