Individual
SHANNON MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
363 MCKNIGHT AVE, WEST FORK, AR 72774-0000
(479) 839-3035
Mailing address
11607 CLUB HOUSE PKWY, FARMINGTON, AR 72730-8775
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1338
AR
Other
Enumeration date
06/12/2008
Last updated
04/18/2011
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