Provider Demographics
NPI:1992787097
Name:KUSCH, SHANON RADLEY (MS CCCA FAAA)
Entity type:Individual
Prefix:
First Name:SHANON
Middle Name:RADLEY
Last Name:KUSCH
Suffix:
Gender:F
Credentials:MS CCCA FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2570
Mailing Address - Country:US
Mailing Address - Phone:615-895-8440
Mailing Address - Fax:615-895-0275
Practice Address - Street 1:3650 W ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2202
Practice Address - Country:US
Practice Address - Phone:405-364-2684
Practice Address - Fax:405-364-1802
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA1364231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3967085Medicare ID - Type Unspecified