Provider Demographics
NPI:1114564259
Name:KAUFMAN, SHANA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:
Last Name:KAUFMAN
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 1:2632 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3940
Mailing Address - Country:US
Mailing Address - Phone:845-521-9122
Mailing Address - Fax:
Practice Address - Street 1:2632 LYNN AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3940
Practice Address - Country:US
Practice Address - Phone:845-521-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist