Provider Demographics
NPI:1073571337
Name:GARDNER, SHELLEY REHBERG (MS/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:REHBERG
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17892 SW 12TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-4922
Mailing Address - Country:US
Mailing Address - Phone:954-437-6277
Mailing Address - Fax:954-437-6277
Practice Address - Street 1:17892 SW 12TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-4922
Practice Address - Country:US
Practice Address - Phone:954-437-6277
Practice Address - Fax:954-437-6277
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist