Provider Demographics
NPI:1164630554
Name:SHOOK, JANE (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:SHOOK
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 1:6330 LYNDON B JOHNSON FWY STE 137
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6425
Mailing Address - Country:US
Mailing Address - Phone:972-233-9019
Mailing Address - Fax:
Practice Address - Street 1:6330 LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE 136
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6467
Practice Address - Country:US
Practice Address - Phone:972-233-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist