Provider Demographics
NPI:1508517111
Name:CROUCH, SHAYNA MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:MARIE
Last Name:CROUCH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:MARIE
Other - Last Name:SCHACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3113 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7220
Mailing Address - Country:US
Mailing Address - Phone:308-390-7514
Mailing Address - Fax:
Practice Address - Street 1:3113 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-7220
Practice Address - Country:US
Practice Address - Phone:308-390-7514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist