Provider Demographics
NPI:1962613042
Name:SHIKANY, SUSAN LYNNE (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNNE
Last Name:SHIKANY
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LYNNE
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 FARMER RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-9509
Mailing Address - Country:US
Mailing Address - Phone:417-742-0930
Mailing Address - Fax:417-742-0841
Practice Address - Street 1:WILLARD R-II
Practice Address - Street 2:407 FARMER RD
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9509
Practice Address - Country:US
Practice Address - Phone:417-742-0930
Practice Address - Fax:417-742-0841
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist