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Individual

SHAUNA LYNN DETIENNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, CCC-SLP

Contact information

Practice address
2951 S 34TH ST, GRAND FORKS, ND 58201-6061
(701) 772-3851
(701) 772-3852
Mailing address
5760 PINEHURST CT, GRAND FORKS, ND 58201-2812
(701) 795-2531

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
603
ND

Other

Enumeration date
06/15/2007
Last updated
07/08/2007
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