Provider Demographics
NPI:1649460700
Name:ROMICK, SHANI KELLY (MS, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:SHANI
Middle Name:KELLY
Last Name:ROMICK
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 YORKSHIRE TRL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5242
Mailing Address - Country:US
Mailing Address - Phone:972-754-1234
Mailing Address - Fax:972-599-9900
Practice Address - Street 1:17300 PRESTON RD
Practice Address - Street 2:STE. 160
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5654
Practice Address - Country:US
Practice Address - Phone:972-754-1234
Practice Address - Fax:972-599-9900
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist