Provider Demographics
NPI:1205956679
Name:PEREZ, SHANA C (M S CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:C
Last Name:PEREZ
Suffix:
Gender:F
Credentials:M S CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625-2000
Mailing Address - Country:US
Mailing Address - Phone:417-847-6406
Mailing Address - Fax:
Practice Address - Street 1:22808 E HIGHWAY 86
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:MO
Practice Address - Zip Code:64844-7416
Practice Address - Country:US
Practice Address - Phone:417-628-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist