Provider Demographics
NPI:1427481530
Name:PEARCE, SHAWNA MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MICHELLE
Last Name:PEARCE
Suffix:
Gender:F
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 1:3455 POLO RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4859
Mailing Address - Country:US
Mailing Address - Phone:336-462-7911
Mailing Address - Fax:
Practice Address - Street 1:3455 POLO RD
Practice Address - Street 2:SUITE 109
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4859
Practice Address - Country:US
Practice Address - Phone:336-462-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist