MEDICARE: MRS. SHANNA CHRISTINA VAN DER SCHANS M. ED. BCBA

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	103K00000X	Behavior Analyst	1-04-1752

General Provider Information

NPI Number	:	1942527163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNA CHRISTINA VAN DER SCHANS M. ED. BCBA

Provider Business Mailing Address
First Line	:	5162 IMOGENE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-2606
Country	:	US
Telephone Number	:	281-468-3883
Fax Number	:

Provider Business Practice Location Address
First Line	:	5162 IMOGENE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-2606
Country	:	US
Telephone Number	:	281-468-3883
Fax Number	:

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

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	07/29/2014

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Directions to “ MRS. SHANNA CHRISTINA VAN DER SCHANS M. ED. BCBA” Practice Location

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