Provider Demographics
NPI:1801926985
Name:GORMAN, SHAUNA MICHELLE
Entity type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:MICHELLE
Last Name:GORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 E WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3038
Mailing Address - Country:US
Mailing Address - Phone:480-862-9420
Mailing Address - Fax:
Practice Address - Street 1:10810 N TATUM BLVD
Practice Address - Street 2:SUITE 102-185
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6055
Practice Address - Country:US
Practice Address - Phone:602-326-2619
Practice Address - Fax:602-297-6727
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNONE2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPA6317OtherDEPT OF HEALTH SERVICES LICENSE