Provider Demographics
NPI:1114184975
Name:BARRETT-VIGILANCE, SHAUN CAROLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHAUN
Middle Name:CAROLE
Last Name:BARRETT-VIGILANCE
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 1:6044 MAINSAIL LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3544
Mailing Address - Country:US
Mailing Address - Phone:757-484-4522
Mailing Address - Fax:
Practice Address - Street 1:6044 MAINSAIL LN
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3544
Practice Address - Country:US
Practice Address - Phone:757-484-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist