Provider Demographics
NPI:1548473200
Name:SHIELDS, LINDA SUSAN (MA)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUSAN
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20546 N BIG DIPPER DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-3161
Mailing Address - Country:US
Mailing Address - Phone:602-717-0512
Mailing Address - Fax:
Practice Address - Street 1:45012 W HONEYCUTT AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239-2842
Practice Address - Country:US
Practice Address - Phone:520-568-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#SLPL4858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist