Provider Demographics
NPI:1356511315
Name:ANESHANSLEY, SHANE CARPENTER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:CARPENTER
Last Name:ANESHANSLEY
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:PO BOX 1569, 100 N. 30TH STREET
Mailing Address - Street 2:INTEGRIS CLINTON REGIONAL HOSPITAL
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601
Mailing Address - Country:US
Mailing Address - Phone:580-323-8273
Mailing Address - Fax:
Practice Address - Street 1:100 NORTH 30TH STREET
Practice Address - Street 2:INTEGRIS CLINTON REGIONAL HOSPITAL
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601
Practice Address - Country:US
Practice Address - Phone:580-323-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist