Provider Demographics
NPI:1730867516
Name:SHASTA SPEECH AND LANGUAGE PATHOLOGY INC.
Entity type:Organization
Organization Name:SHASTA SPEECH AND LANGUAGE PATHOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:530-244-0263
Mailing Address - Street 1:2208 PARK MARINA DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2111
Mailing Address - Country:US
Mailing Address - Phone:530-244-0263
Mailing Address - Fax:530-247-0688
Practice Address - Street 1:2208 PARK MARINA DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2111
Practice Address - Country:US
Practice Address - Phone:530-244-0263
Practice Address - Fax:530-247-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty