Provider Demographics
NPI:1265020648
Name:CLIFFORD, SHAUNA IRENE (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:IRENE
Last Name:CLIFFORD
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 1:142 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2136
Mailing Address - Country:US
Mailing Address - Phone:203-500-8247
Mailing Address - Fax:
Practice Address - Street 1:142 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2136
Practice Address - Country:US
Practice Address - Phone:203-500-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18.006253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist