Doctor Name: | GINA LEE SHELLEY |
NPI Number: | 1063792851 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., CCC-SLP |
License Number: | 01413 |
Business Practice Address: | 210 Summit Ridge Pl Weldon Spring, MO - 633040907 |
Business Phone Number: | 6362442134 |
Business Fax Number: | |
Mailing Address: | 6420 Clayton Road, Ssm Rehabilitation Hospital ST. LOUIS |
State: | MO |
Postal Code: | 63117 |
Phone Number: | 3147685338 |
Fax Number: | 3147685208 |
NPI Enumeration Date: | 08/24/2011 |
NPI Last Update Date: | 08/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 01413 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |