Provider Demographics
NPI:1942795810
Name:MOTZ, SHANNON (SLP INTERN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MOTZ
Suffix:
Gender:F
Credentials:SLP INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 OAKRIDGE AVE APT 1301
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-1857
Mailing Address - Country:US
Mailing Address - Phone:325-428-8611
Mailing Address - Fax:
Practice Address - Street 1:3708 20TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1228
Practice Address - Country:US
Practice Address - Phone:806-744-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-24
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist