Provider Demographics
NPI:1801024906
Name:SHIELDS, SUSAN SINNAMON (MS, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SINNAMON
Last Name:SHIELDS
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 1:6226 COLLEYVILLE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6277
Mailing Address - Country:US
Mailing Address - Phone:817-251-9527
Mailing Address - Fax:817-251-9549
Practice Address - Street 1:6226 COLLEYVILLE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6277
Practice Address - Country:US
Practice Address - Phone:817-251-9527
Practice Address - Fax:817-251-9549
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist