Provider Demographics
NPI:1699938555
Name:MURPHY, SHAWNA (SLP)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 N 2538 E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5772
Mailing Address - Country:US
Mailing Address - Phone:208-732-8414
Mailing Address - Fax:
Practice Address - Street 1:3785 N 2538 E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5772
Practice Address - Country:US
Practice Address - Phone:208-732-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP 1450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDSP055OtherBLUE CROSS OF IDAHO
ID808103200Medicaid