Provider Demographics
NPI:1033756069
Name:BALLARD, SHELBI LYN (SLP)
Entity Type:Individual
Prefix:
First Name:SHELBI
Middle Name:LYN
Last Name:BALLARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-3501
Mailing Address - Country:US
Mailing Address - Phone:318-396-1969
Mailing Address - Fax:
Practice Address - Street 1:4401 STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2339
Practice Address - Country:US
Practice Address - Phone:318-232-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA8100OtherLA SPEECH LICENSE