Provider Demographics
NPI:1003087578
Name:GIBSON, SHANUN MICAELA (MS,CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:SHANUN
Middle Name:MICAELA
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:SHANUN
Other - Middle Name:MICAELA
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC/SLP
Mailing Address - Street 1:9031 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73179-2818
Mailing Address - Country:US
Mailing Address - Phone:405-732-3946
Mailing Address - Fax:405-261-6311
Practice Address - Street 1:9031 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73179-2818
Practice Address - Country:US
Practice Address - Phone:405-732-3946
Practice Address - Fax:405-261-6311
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist