Provider Demographics
NPI:1598648123
Name:CALDWELL, SHANNA GRACE
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:GRACE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 TOPWATER DR APT 104
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-0058
Mailing Address - Country:US
Mailing Address - Phone:256-808-4657
Mailing Address - Fax:
Practice Address - Street 1:325 SOUND RD STE 200
Practice Address - Street 2:
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-7813
Practice Address - Country:US
Practice Address - Phone:910-541-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30004371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist