Provider Demographics
NPI:1699216135
Name:NOAH, SHANA LATOI (MED, MS, CCC-SL)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:LATOI
Last Name:NOAH
Suffix:
Gender:F
Credentials:MED, MS, CCC-SL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 W. SAGE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713
Mailing Address - Country:US
Mailing Address - Phone:409-866-7255
Mailing Address - Fax:409-866-7255
Practice Address - Street 1:1715 W. SAGE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-5603
Practice Address - Country:US
Practice Address - Phone:409-866-7255
Practice Address - Fax:409-866-7255
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist