Provider Demographics
NPI:1174831879
Name:DEAL, SHANA MICHELLE (SLP/CCC)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:MICHELLE
Last Name:DEAL
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 WHIPPORWILL LN
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-3880
Mailing Address - Country:US
Mailing Address - Phone:903-984-6264
Mailing Address - Fax:903-984-6264
Practice Address - Street 1:1901 WHIPPORWILL LN
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3880
Practice Address - Country:US
Practice Address - Phone:903-984-6264
Practice Address - Fax:903-984-6264
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist