Provider Demographics
NPI:1427194141
Name:OLIVER, SHAWN DAVID (CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:DAVID
Last Name:OLIVER
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3228
Mailing Address - Country:US
Mailing Address - Phone:573-449-1137
Mailing Address - Fax:
Practice Address - Street 1:2005 ROSE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3228
Practice Address - Country:US
Practice Address - Phone:573-449-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006029250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist