Provider Demographics
NPI:1780127373
Name:GAUNT, SHANDA GWEN (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:GWEN
Last Name:GAUNT
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 1:5436 KAHLER DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301
Mailing Address - Country:US
Mailing Address - Phone:763-370-9860
Mailing Address - Fax:
Practice Address - Street 1:11091 JASEN AVE NE SUITE 2
Practice Address - Street 2:COURAGE KENNY REHABILITATION INSTITUTE ALBERTVILLE PART
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301
Practice Address - Country:US
Practice Address - Phone:763-744-4160
Practice Address - Fax:763-497-0679
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist