Provider Demographics
NPI:1518104033
Name:SHUTE, SHAWNTELLE DEONE (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNTELLE
Middle Name:DEONE
Last Name:SHUTE
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12899 E 76TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4021
Mailing Address - Country:US
Mailing Address - Phone:918-609-6003
Mailing Address - Fax:
Practice Address - Street 1:12899 E 76TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4021
Practice Address - Country:US
Practice Address - Phone:918-609-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist