Provider Demographics
NPI:1689363566
Name:SHANK, JOHN PARKER
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PARKER
Last Name:SHANK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S WILLIWAW DR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7023
Mailing Address - Country:US
Mailing Address - Phone:907-399-2227
Mailing Address - Fax:
Practice Address - Street 1:7200 JIM COTTRELL CIRCLE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-982-3897
Practice Address - Fax:866-283-2986
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist