Provider Demographics
NPI:1124231980
Name:FROST, SHAYNA LATRICE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHAYNA
Middle Name:LATRICE
Last Name:FROST
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 FRANK SCOTT PKWY W
Mailing Address - Street 2:STE 824
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5007
Mailing Address - Country:US
Mailing Address - Phone:618-234-9705
Mailing Address - Fax:618-257-0665
Practice Address - Street 1:2810 FRANK SCOTT PKWY W
Practice Address - Street 2:STE 824
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5007
Practice Address - Country:US
Practice Address - Phone:618-234-9705
Practice Address - Fax:618-257-0665
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2273235Z00000X
IL146010914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157410721Medicaid
AR5Y615OtherBLUE CROSS BLUE SHIELD