Provider Demographics
NPI:1770902496
Name:BOONE, SHANI (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANI
Middle Name:
Last Name:BOONE
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 1:5030 VIA PRIMARIA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4535
Mailing Address - Country:US
Mailing Address - Phone:714-695-0399
Mailing Address - Fax:
Practice Address - Street 1:18726 S WESTERN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3813
Practice Address - Country:US
Practice Address - Phone:714-343-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP10719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist