Provider Demographics
NPI:1033447784
Name:SHAIN, JOHNNA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JOHNNA
Middle Name:
Last Name:SHAIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 NW AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3007
Mailing Address - Country:US
Mailing Address - Phone:806-787-6441
Mailing Address - Fax:
Practice Address - Street 1:207 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-4305
Practice Address - Country:US
Practice Address - Phone:432-758-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist