Provider Demographics
NPI:1043449168
Name:SHETLER, EDITH H (SLP)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:H
Last Name:SHETLER
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 1:1213 GARLFIELD AVE.
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537
Mailing Address - Country:US
Mailing Address - Phone:712-755-4342
Mailing Address - Fax:712-755-4513
Practice Address - Street 1:1213 GARLFIED AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537
Practice Address - Country:US
Practice Address - Phone:712-755-4243
Practice Address - Fax:712-755-4513
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1334235Z00000X
IA1941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477700Medicaid