Provider Demographics
NPI:1588433098
Name:SHANKS, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:SHANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6600
Mailing Address - Country:US
Mailing Address - Phone:843-376-3430
Mailing Address - Fax:888-965-6992
Practice Address - Street 1:905 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6600
Practice Address - Country:US
Practice Address - Phone:843-376-3430
Practice Address - Fax:888-965-6992
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-0742237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist