Doctor Name: | SHANNA LEE STACK |
NPI Number: | 1346682911 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SLP-SP-TMP-3159 |
Business Practice Address: | 2331 S. 7th St. W. Missoula, MT - 59801 |
Business Phone Number: | 4065461103 |
Business Fax Number: | |
Mailing Address: | 2331 S 7th St W, MISSOULA |
State: | MT |
Postal Code: | 598012113 |
Phone Number: | 4065461103 |
Fax Number: | |
NPI Enumeration Date: | 07/24/2013 |
NPI Last Update Date: | 07/24/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP-SP-TMP-3159 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |