Doctor Name: | SHELLEY INDILICATO |
NPI Number: | 1710284385 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SLP7058 |
Business Practice Address: | 3745 E Ravenswood Dr Gilbert, AZ - 852989124 |
Business Phone Number: | 4804148263 |
Business Fax Number: | |
Mailing Address: | 3745 E Ravenswood Dr, GILBERT |
State: | AZ |
Postal Code: | 852989124 |
Phone Number: | 4804148263 |
Fax Number: | |
NPI Enumeration Date: | 02/17/2011 |
NPI Last Update Date: | 02/17/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP7058 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
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 |