Provider Demographics
NPI:1558032185
Name:MCSHANE, CAROL CATHERINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:CATHERINE
Last Name:MCSHANE
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 1:6107 CRAIGWAY RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-3705
Mailing Address - Country:US
Mailing Address - Phone:832-389-9694
Mailing Address - Fax:
Practice Address - Street 1:CONROE ISD
Practice Address - Street 2:3205 W. DAVIS STREET
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-709-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist