Provider Demographics
NPI:1497114276
Name:BARNES, SHAWANDA (SLP)
Entity Type:Individual
Prefix:
First Name:SHAWANDA
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5466 BRANCHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7487
Mailing Address - Country:US
Mailing Address - Phone:662-207-7172
Mailing Address - Fax:
Practice Address - Street 1:5466 BRANCHVIEW DR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7487
Practice Address - Country:US
Practice Address - Phone:662-207-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist