Provider Demographics
NPI:1851762637
Name:SHATSWELL, GENA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:SHATSWELL
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 1:401 W TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1529
Mailing Address - Country:US
Mailing Address - Phone:580-482-7308
Mailing Address - Fax:580-477-2763
Practice Address - Street 1:401 W TAMARACK RD
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1529
Practice Address - Country:US
Practice Address - Phone:580-482-7308
Practice Address - Fax:580-477-2763
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist