Provider Demographics
NPI:1245517374
Name:SHOEMAKER, JEFFREY ROBERT (SLP)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROBERT
Last Name:SHOEMAKER
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PALM VALLEY DR W APT 2
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-9003
Mailing Address - Country:US
Mailing Address - Phone:218-234-6411
Mailing Address - Fax:
Practice Address - Street 1:1400 PALM VALLEY DR W APT 2
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-9003
Practice Address - Country:US
Practice Address - Phone:218-234-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105523235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist