Provider Demographics
NPI:1518455682
Name:ENGRAM-KITCHIN, SHANA (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:ENGRAM-KITCHIN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:ENGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:1211 DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1156
Mailing Address - Country:US
Mailing Address - Phone:248-275-3295
Mailing Address - Fax:
Practice Address - Street 1:1211 DRAKE AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94579-1156
Practice Address - Country:US
Practice Address - Phone:248-275-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CA26980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist