Provider Demographics
NPI:1053466052
Name:READ, SHAWNA A (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:A
Last Name:READ
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 1:108 N JANE ANN ST
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63730-8145
Mailing Address - Country:US
Mailing Address - Phone:573-450-5053
Mailing Address - Fax:
Practice Address - Street 1:108 N JANE ANN ST
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:MO
Practice Address - Zip Code:63730-8145
Practice Address - Country:US
Practice Address - Phone:573-450-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003020839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist