Provider Demographics
NPI:1912085895
Name:GREEN, SHIRLEY N (BC-IHS, ACA)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:N
Last Name:GREEN
Suffix:
Gender:F
Credentials:BC-IHS, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 DALLAS DR
Mailing Address - Street 2:STE 6
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-5100
Mailing Address - Country:US
Mailing Address - Phone:940-387-2195
Mailing Address - Fax:940-565-5973
Practice Address - Street 1:1121 DALLAS DR
Practice Address - Street 2:STE 6
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-5100
Practice Address - Country:US
Practice Address - Phone:940-387-2195
Practice Address - Fax:940-565-5973
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50071237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter