Shamballa Enterprises, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

SHAMBALLA ENTERPRISES, LLC

Practice address

3460 S Western Way
Tucson, AZ 85735-5104

Phone

(520) 908-8988

NPI assigned

Feb 6, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Vicki Goodwin, CCC-SLP

Title

Owner

Phone

(520) 908-8988

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233878400000",
    "number": "1669611158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3460 S WESTERN WAY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857355104",
            "telephone_number": "520-908-8988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 S WESTERN WAY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857355104",
            "telephone_number": "520-908-8988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAMBALLA ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-06",
        "last_updated": "2009-02-06",
        "status": "A",
        "authorized_official_last_name": "GOODWIN",
        "authorized_official_first_name": "VICKI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-908-8988",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; 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.