Doctor Name: | MR. KENTON O SHAW |
NPI Number: | 1912345687 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | SP 0000004254 |
Business Practice Address: | 139 Maple Row Blvd Suite 202 Hendersonville, TN - 370754487 |
Business Phone Number: | 6158267113 |
Business Fax Number: | |
Mailing Address: | 105 Heathcote Ct, GOODLETTSVILLE |
State: | TN |
Postal Code: | 370722116 |
Phone Number: | 6153372969 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2013 |
NPI Last Update Date: | 06/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP 0000004254 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
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 |