Basic Information
| Provider Information | |||||||||
| NPI: | 1235753021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REED | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | JUSTIN | ||||||||
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| Credential: | CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6907 SHAWNEE MISSION PKWY | ||||||||
| Address2: | 207 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889131910 | ||||||||
| FaxNumber: | 8779131174 | ||||||||
| Practice Location | |||||||||
| Address1: | 6907 SHAWNEE MISSION PKWY | ||||||||
| Address2: | 207 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889131910 | ||||||||
| FaxNumber: | 8779131174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2020 | ||||||||
| LastUpdateDate: | 06/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.