Provider Demographics
NPI:1114690450
Name:SHANKS, DANA (MA)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:SHANKS
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 1:14884 E SUNDANCE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7162
Mailing Address - Country:US
Mailing Address - Phone:316-841-9567
Mailing Address - Fax:
Practice Address - Street 1:14884 E SUNDANCE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67230-7162
Practice Address - Country:US
Practice Address - Phone:316-841-9567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3972OtherKANSAS DEPARTMENT OF HEALTH OCCUPATIONS CREDENTIALING NUMBER