Provider Demographics
NPI:1558917005
Name:FILLIPOVICH, SHAYNA (MA, SLP-CCC)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:FILLIPOVICH
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E VAN BUREN ST APT 2111
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-4037
Mailing Address - Country:US
Mailing Address - Phone:740-827-5048
Mailing Address - Fax:
Practice Address - Street 1:3348 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2499
Practice Address - Country:US
Practice Address - Phone:602-455-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP27916235Z00000X
AZSLP11808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist