Provider Demographics
NPI:1992873681
Name:SHEA, ANN KATHLEEN (AUD, MA, CCC-A/SLP)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:KATHLEEN
Last Name:SHEA
Suffix:
Gender:F
Credentials:AUD, MA, CCC-A/SLP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:KATHLEEN
Other - Last Name:HEMME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10200 CRUMLEY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6011
Mailing Address - Country:US
Mailing Address - Phone:605-391-8407
Mailing Address - Fax:
Practice Address - Street 1:10200 CRUMLEY RANCH RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6011
Practice Address - Country:US
Practice Address - Phone:605-391-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5831473235Z00000X
TX80362231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5831473Medicaid
SD5831473Medicaid