Provider Demographics
NPI:1316258007
Name:BAZALDUA, SHANNON ESSE (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ESSE
Last Name:BAZALDUA
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17198 ST LUKES WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8011
Mailing Address - Country:US
Mailing Address - Phone:936-321-0808
Mailing Address - Fax:
Practice Address - Street 1:17198 ST LUKES WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8011
Practice Address - Country:US
Practice Address - Phone:936-321-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51262231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist