Provider Demographics
NPI:1134446982
Name:MCINTYRE, SHAYE LYNNE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHAYE
Middle Name:LYNNE
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:SHAYE
Other - Middle Name:LYNNE
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:620 N. ALLEGHANEY AVE.
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761
Mailing Address - Country:US
Mailing Address - Phone:432-332-8244
Mailing Address - Fax:432-580-7428
Practice Address - Street 1:620 N. ALLEGHANEY AVE.
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-332-8244
Practice Address - Fax:432-580-7428
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104418OtherLICENSE NUMBER