Provider Demographics
NPI:1043717531
Name:GUNDERSON, SHELBY (SLP-CF)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 HURON ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2933
Mailing Address - Country:US
Mailing Address - Phone:920-901-3115
Mailing Address - Fax:
Practice Address - Street 1:2901 FINLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1774
Practice Address - Country:US
Practice Address - Phone:630-495-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist