Provider Demographics
NPI:1437467370
Name:EUBANK, SHAINA RENEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:RENEE
Last Name:EUBANK
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 1:232 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4569
Mailing Address - Country:US
Mailing Address - Phone:270-566-1158
Mailing Address - Fax:
Practice Address - Street 1:232 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4569
Practice Address - Country:US
Practice Address - Phone:270-566-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist