Provider Demographics
NPI:1346456290
Name:FRANTSVOG, SHANDA A (MSCCC)
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:A
Last Name:FRANTSVOG
Suffix:
Gender:F
Credentials:MSCCC
Other - Prefix:
Other - First Name:SHANDA
Other - Middle Name:A
Other - Last Name:ENTZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:TRINITY HOSPITALS
Mailing Address - Street 2:1 W BURDICK EXPY
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701
Mailing Address - Country:US
Mailing Address - Phone:701-857-5105
Mailing Address - Fax:701-857-5646
Practice Address - Street 1:TRINITY HOSPITALS
Practice Address - Street 2:1 W BURDICK EXPY
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-857-5105
Practice Address - Fax:701-857-5646
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist