Provider Demographics
NPI:1205685948
Name:MASON, SHANE (AUD)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2921
Mailing Address - Country:US
Mailing Address - Phone:304-904-7836
Mailing Address - Fax:
Practice Address - Street 1:2012 GARFIELD AVE STE 4
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2541
Practice Address - Country:US
Practice Address - Phone:304-428-2403
Practice Address - Fax:304-428-3270
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0423231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist