Provider Demographics
NPI:1588989552
Name:LUGASSY, SHANEEN MYERS
Entity type:Individual
Prefix:MRS
First Name:SHANEEN
Middle Name:MYERS
Last Name:LUGASSY
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 1:17216 SATICOY ST STE 141
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2103
Mailing Address - Country:US
Mailing Address - Phone:818-206-3353
Mailing Address - Fax:
Practice Address - Street 1:1611 E 4TH ST STE 230
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5136
Practice Address - Country:US
Practice Address - Phone:714-494-7551
Practice Address - Fax:714-573-4944
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9615235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist