Basic Information
| Provider Information | |||||||||
| NPI: | 1346456290 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANTSVOG | ||||||||
| FirstName: | SHANDA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.S.CCC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ENTZEL | ||||||||
| OtherFirstName: | SHANDA | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | TRINITY HOSPITALS | ||||||||
| Address2: | 1 W BURDICK EXPY | ||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018575105 | ||||||||
| FaxNumber: | 7018575646 | ||||||||
| Practice Location | |||||||||
| Address1: | TRINITY HOSPITALS | ||||||||
| Address2: | 1 W BURDICK EXPY | ||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018575105 | ||||||||
| FaxNumber: | 7018575646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 11/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 833 | ND | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.