Provider Demographics
NPI:1114262250
Name:MCGILL, SHANA LORENE (MED CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SHANA
Middle Name:LORENE
Last Name:MCGILL
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SIGNAL MOUNTAIN RD STE 288
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1823
Mailing Address - Country:US
Mailing Address - Phone:423-498-6546
Mailing Address - Fax:
Practice Address - Street 1:711 SIGNAL MOUNTAIN RD STE 288
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1823
Practice Address - Country:US
Practice Address - Phone:423-498-6546
Practice Address - Fax:423-498-6509
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12153054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist