Provider Demographics
NPI:1649638636
Name:PITCHER, SHANA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:PITCHER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WINDWALKER WAY
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3439
Mailing Address - Country:US
Mailing Address - Phone:415-305-5796
Mailing Address - Fax:
Practice Address - Street 1:104 WINDWALKER WAY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3439
Practice Address - Country:US
Practice Address - Phone:415-305-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP10368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist