Provider Demographics
NPI:1386156016
Name:ARENAL, SHANNON LORENE (MS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LORENE
Last Name:ARENAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2808
Mailing Address - Country:US
Mailing Address - Phone:661-874-8001
Mailing Address - Fax:
Practice Address - Street 1:226 IRVING AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2808
Practice Address - Country:US
Practice Address - Phone:661-874-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist