Doctor Name: | KELLY SHAW |
NPI Number: | 1790049807 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCC-SLP |
License Number: | 3456-154 |
Business Practice Address: | 5219 88th Ave Kenosha, WI - 531447468 |
Business Phone Number: | 2626530850 |
Business Fax Number: | |
Mailing Address: | 14460 W Honey Ln, NEW BERLIN |
State: | WI |
Postal Code: | 531512314 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/03/2012 |
NPI Last Update Date: | 07/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3456-154 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
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 |