Provider Demographics
NPI:1720864465
Name:MARCONATO, SHAUNA PRAVETTONI (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:PRAVETTONI
Last Name:MARCONATO
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40497 N FRIEND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-8171
Mailing Address - Country:US
Mailing Address - Phone:928-257-2925
Mailing Address - Fax:
Practice Address - Street 1:40497 N FRIEND AVE
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-8171
Practice Address - Country:US
Practice Address - Phone:928-257-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA147242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty