Provider Demographics
NPI:1073760666
Name:LUTTRELL, SHAYNA JANE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHAYNA
Middle Name:JANE
Last Name:LUTTRELL
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:SHAYNE
Other - Middle Name:JANE
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 HUNTERS DR
Mailing Address - Street 2:
Mailing Address - City:VINE GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:40175-7103
Mailing Address - Country:US
Mailing Address - Phone:270-307-8136
Mailing Address - Fax:
Practice Address - Street 1:230 HUNTERS DR
Practice Address - Street 2:
Practice Address - City:VINE GROVE
Practice Address - State:KY
Practice Address - Zip Code:40175-7103
Practice Address - Country:US
Practice Address - Phone:270-307-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist