Provider Demographics
NPI:1447239280
Name:SHAW, JANELLE R (AUD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:R
Last Name:SHAW
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:7379 W MONTE CRISTO AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14506 W GRANITE VALLEY DR STE 117
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85375-6011
Practice Address - Country:US
Practice Address - Phone:480-998-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1750231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ859811Medicaid
AZ859811Medicaid