Provider Demographics
NPI:1790017432
Name:TANTON, SHANDRA DALEE (MS CF/SLP)
Entity type:Individual
Prefix:
First Name:SHANDRA
Middle Name:DALEE
Last Name:TANTON
Suffix:
Gender:F
Credentials:MS CF/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 BILL BRADFORD
Mailing Address - Street 2:STE 101
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4538
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:614 BILL BRADFORD
Practice Address - Street 2:STE 101
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4538
Practice Address - Country:US
Practice Address - Phone:903-885-5919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist