Doctor Name: | DR. SHELLIE DEE LOCKE |
NPI Number: | 1336319979 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 2660-057 |
Business Practice Address: | 9020 15th Ave Kenosha, WI - 531436803 |
Business Phone Number: | 7082247442 |
Business Fax Number: | |
Mailing Address: | 9020 15th Ave, KENOSHA |
State: | WI |
Postal Code: | 531436803 |
Phone Number: | 7082247442 |
Fax Number: | |
NPI Enumeration Date: | 03/11/2008 |
NPI Last Update Date: | 03/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 2660-057 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |