Doctor Name: | MS. SHAYNE BUNDREN |
NPI Number: | 1558697771 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 146005911 |
Business Practice Address: | 722 Renshaw Ave Apartment 15 Carmi, IL - 628211579 |
Business Phone Number: | 6183834501 |
Business Fax Number: | |
Mailing Address: | 722 Renshaw Ave, Apartment 15 CARMI |
State: | IL |
Postal Code: | 628211579 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/22/2009 |
NPI Last Update Date: | 10/22/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 146005911 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
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 |