Provider Demographics
NPI:1821279290
Name:SHUMATE, TRICIA ANNE (MS SPEECH LANGUAGE P)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:ANNE
Last Name:SHUMATE
Suffix:
Gender:F
Credentials:MS SPEECH LANGUAGE P
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:GARSIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 MORDINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414
Mailing Address - Country:US
Mailing Address - Phone:304-725-9741
Mailing Address - Fax:304-724-5311
Practice Address - Street 1:103 SHENANDOAH JUNCTION ROAD
Practice Address - Street 2:TA LOWERY ELEMENTARY SCHOOL
Practice Address - City:SHENANDOAH JUNCTION
Practice Address - State:WV
Practice Address - Zip Code:25442
Practice Address - Country:US
Practice Address - Phone:304-728-7250
Practice Address - Fax:304-728-7631
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00926758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0155529000Medicaid