Provider Demographics
NPI:1144431099
Name:SHANTZ, JODELL M (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:JODELL
Middle Name:M
Last Name:SHANTZ
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 S 174TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3620
Mailing Address - Country:US
Mailing Address - Phone:402-933-5107
Mailing Address - Fax:
Practice Address - Street 1:8031 W CENTER RD
Practice Address - Street 2:SUITE 225
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3158
Practice Address - Country:US
Practice Address - Phone:402-391-5002
Practice Address - Fax:402-343-1278
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist