Basic Information
| Provider Information | |||||||||
| NPI: | 1942627682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | SHELLY | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16460 HIGHWAY 3 | ||||||||
| Address2: | #1306 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775986212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8327857173 | ||||||||
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| Practice Location | |||||||||
| Address1: | 304 TANGLEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775394333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815346755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2014 | ||||||||
| LastUpdateDate: | 03/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 19513 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.