Provider Demographics
NPI:1043524754
Name:SHUNE, SAMANTHA EVE (SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:EVE
Last Name:SHUNE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 TOWNCREST DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6631
Mailing Address - Country:US
Mailing Address - Phone:319-354-2429
Mailing Address - Fax:319-354-6100
Practice Address - Street 1:540 E JEFFERSON ST STE 302
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2460
Practice Address - Country:US
Practice Address - Phone:319-339-3611
Practice Address - Fax:319-339-3878
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665463Medicaid
IA166546Medicare UPIN