Provider Demographics
NPI:1356536601
Name:WAINE-SHOTLAND, ZILLAH B (MA)
Entity type:Individual
Prefix:MS
First Name:ZILLAH
Middle Name:B
Last Name:WAINE-SHOTLAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 LITTLE WOLF RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8786
Mailing Address - Country:US
Mailing Address - Phone:406-600-5674
Mailing Address - Fax:
Practice Address - Street 1:144 LITTLE WOLF RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8786
Practice Address - Country:US
Practice Address - Phone:406-600-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist