Individual
SHANNON K RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLPA
Contact information
Practice address
2172 N ARIZOLA RD, CASA GRANDE, AZ 85122-6372
(520) 876-5397
Mailing address
220 W KORTSEN RD, CASA GRANDE, AZ 85122-5910
(520) 876-3242
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SLPA10368
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLPA10368
SLPA LICENCE
AZ
Enumeration date
08/15/2017
Last updated
08/15/2017
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