Russell, Shane Renee
Russell, Shane Renee is an sole proprietor health care provider with primary practice located at 247 Sw Long Leaf Dr , Lake City FL 32024-4241. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Russell, Shane Renee can be contacted via phone (386) 752-3274.Contact Information
Primary practice address
247 Sw Long Leaf Dr
Lake City FL 32024-4241
Phone: (386) 752-3274
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | SA7504 | Florida |
Profile Details
| NPI number | 1548361850 |
|---|---|
| LBN Legal business name | Russell, Shane Renee |
| Credentials | MS CCC-SLP |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 26th, 2006 |
| Last updated | Jul 9th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548361850 | NPPES |
| Florida | MEDICAID | 89142810000 |
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