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NPI Code Detail

MEDICARE: TONYA SHANKLE

MEDICARE: TONYA SHANKLE
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
11041C0700XClinical Social Worker
21041C0700XClinical Social Worker64687TX

General Provider Information

NPI Number : 1639535149
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA SHANKLE
Provider Business Mailing Address
First Line : 183 HIVER CIR
Second Line :
City : KYLE
State : TX
Zip : 78640-5501
Country : US
Telephone Number : 737-303-6780
Fax Number :
Provider Business Practice Location Address
First Line : 10816 CROWN COLONY DR STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78747-1639
Country : US
Telephone Number : 541-519-6191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2016
Last Update Date : 03/03/2023

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Directions to “ TONYA SHANKLE ” Practice Location

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