Provider Demographics
NPI:1609389303
Name:SHANBOUR, CAROLINE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:SHANBOUR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW 66TH ST STE 925
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-8227
Mailing Address - Country:US
Mailing Address - Phone:405-808-6598
Mailing Address - Fax:
Practice Address - Street 1:200 NW 66TH ST STE 925
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8227
Practice Address - Country:US
Practice Address - Phone:405-808-6598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist