Provider Demographics
NPI:1043382179
Name:SHEARD, DOROTHY LOUISE (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LOUISE
Last Name:SHEARD
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004
Mailing Address - Country:US
Mailing Address - Phone:509-235-5303
Mailing Address - Fax:
Practice Address - Street 1:9212 E MONTGOMERY AVE
Practice Address - Street 2:#103
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4239
Practice Address - Country:US
Practice Address - Phone:509-922-0855
Practice Address - Fax:509-921-0050
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001811235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8362667Medicaid