Provider Demographics
NPI:1053677476
Name:SHAMBOURGER, SHAWNA (MA)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:SHAMBOURGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10680 N RUSHMORE DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-0628
Mailing Address - Country:US
Mailing Address - Phone:559-250-8380
Mailing Address - Fax:
Practice Address - Street 1:149 OAK AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-7228
Practice Address - Country:US
Practice Address - Phone:559-250-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP12606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist