Provider Demographics
NPI:1366733891
Name:TOGNAZZINI, SHANA RENEE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:RENEE
Last Name:TOGNAZZINI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE MULTNOMAH ST STE 870
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-4112
Mailing Address - Country:US
Mailing Address - Phone:503-238-5559
Mailing Address - Fax:
Practice Address - Street 1:700 NE MULTNOMAH ST STE 870
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4112
Practice Address - Country:US
Practice Address - Phone:503-238-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13362235Z00000X
WALL 60315236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR12137945OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
OR13362OtherBOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY
WALL 60315236OtherWASHINGTON STATE DEPARTMENT OF HEALTH