Provider Demographics
NPI:1467135426
Name:TRUJILLO, SHANNEN RENEE (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNEN
Middle Name:RENEE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:SHANNEN
Other - Middle Name:RENEE
Other - Last Name:KRAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5035 N DESERT LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-4311
Mailing Address - Country:US
Mailing Address - Phone:928-710-1036
Mailing Address - Fax:
Practice Address - Street 1:1 N WILLARD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3651
Practice Address - Country:US
Practice Address - Phone:928-634-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP146762355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant