| NPI | 1568445708 |
|---|---|
| Former Name | SHANNA RENEE HEADLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WI 3872) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: MT 1203) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2019-06-18 |