Provider Demographics
NPI:1922441336
Name:MANVELL, SHAWN MICHELE
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MICHELE
Last Name:MANVELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 GRANADA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7866
Mailing Address - Country:US
Mailing Address - Phone:805-383-1501
Mailing Address - Fax:805-384-0478
Practice Address - Street 1:155 GRANADA ST
Practice Address - Street 2:SUITE C
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7866
Practice Address - Country:US
Practice Address - Phone:805-383-1501
Practice Address - Fax:805-384-0478
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist