Provider Demographics
NPI:1821528639
Name:WESTBURY, SHONTA TENISHA (MA CCC - SLP)
Entity Type:Individual
Prefix:
First Name:SHONTA
Middle Name:TENISHA
Last Name:WESTBURY
Suffix:
Gender:F
Credentials:MA CCC - SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 DELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-3912
Mailing Address - Country:US
Mailing Address - Phone:803-290-4213
Mailing Address - Fax:
Practice Address - Street 1:1890 DELLWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115
Practice Address - Country:US
Practice Address - Phone:803-290-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5838235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist