Provider Demographics
NPI:1164504056
Name:CARROLL, SHANA WOOD (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SHANA
Middle Name:WOOD
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:WOOD
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:270 CONIFER WAY
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-7302
Mailing Address - Country:US
Mailing Address - Phone:704-473-1675
Mailing Address - Fax:980-701-0008
Practice Address - Street 1:270 CONIFER WAY
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-7302
Practice Address - Country:US
Practice Address - Phone:828-506-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127VROtherBCBSNC
NC7412635Medicaid