Shanna Headley Davis, MS CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3872 Issued in WI

Practice address

1700 Midway Rd
Menasha, WI 54952-1230

Phone

(406) 223-9241

NPI assigned

Nov 22, 2005

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

• Miss Shanna Renee Headley Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 18, 2019.

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1568445708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 MIDWAY RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521230",
            "telephone_number": "406-223-9241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MIDWAY RD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521230",
            "telephone_number": "406-223-9241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "SHANNA",
        "middle_name": "HEADLEY",
        "name_prefix": "Mrs.",
        "credential": "MS CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-22",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MT",
            "license": "1203",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "3872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Menasha",
            "affiliation": "N",
            "address_1": "1700 Midway Rd",
            "city": "Menasha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549521230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHANNA",
            "last_name": "HEADLEY",
            "middle_name": "RENEE",
            "prefix": "MISS",
            "credential": "MS CCC SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Matthew William Czerwan
• Kortney Dahm
• Vonda B Dahms, APNP
• Kathi Danke, LPC
• Olivia Davel
• Catalina De Luna, LPC-IT, MSE
• David Arthur De Pas, D.D.S.
• Susan Kay De Pas, D.D.S.
• Andrew C De Wet, DDS
• Greg A Delaney, CSAC

• All providers in Menasha, WI
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.