Provider Demographics
NPI:1023700044
Name:TEGROTENHUIS, SHAE LYNNE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHAE
Middle Name:LYNNE
Last Name:TEGROTENHUIS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:SHAE
Other - Middle Name:LYNNE
Other - Last Name:ETHERINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:1306 HIGHWAY 57 STE B
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-1075
Mailing Address - Country:US
Mailing Address - Phone:319-346-9783
Mailing Address - Fax:319-346-9785
Practice Address - Street 1:1306 HIGHWAY 57 STE B
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:IA
Practice Address - Zip Code:50665-1075
Practice Address - Country:US
Practice Address - Phone:319-346-9783
Practice Address - Fax:319-346-9785
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA112164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist