| Doctor Name: | SHAUNA LYNN DETIENNE |
| NPI Number: | 1538364070 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, CCC-SLP |
| License Number: | 603 |
| Business Practice Address: | 2951 S 34th St Grand Forks, ND - 582016061 |
| Business Phone Number: | 7017723851 |
| Business Fax Number: | 7017723852 |
| Mailing Address: | 5760 Pinehurst Ct, GRAND FORKS |
| State: | ND |
| Postal Code: | 582012812 |
| Phone Number: | 7017952531 |
| Fax Number: | |
| NPI Enumeration Date: | 06/15/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 603 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| 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 |