Provider Demographics
NPI:1356539860
Name:MORAN SHIELDS, ERIN (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:MORAN SHIELDS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:2532 NW 44TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:505-730-9700
Mailing Address - Fax:
Practice Address - Street 1:2532 NW 44TH STREET
Practice Address - Street 2:
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:505-730-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3812235Z00000X
OK4166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist