Provider Demographics
NPI:1346440450
Name:SHEA, GINA LORENE (MS/CF SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LORENE
Last Name:SHEA
Suffix:
Gender:F
Credentials:MS/CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 MORNING VIEW CT APT J209
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1211
Mailing Address - Country:US
Mailing Address - Phone:309-287-4893
Mailing Address - Fax:
Practice Address - Street 1:4317 MORNING VIEW CT APT J209
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1211
Practice Address - Country:US
Practice Address - Phone:309-287-4893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2967-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist