Provider Demographics
NPI:1083747471
Name:LANDRY, SHELLIE (SLP)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:LANDRY
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 1:1205 SAINT CHARLES AVE APT 616
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-8408
Mailing Address - Country:US
Mailing Address - Phone:504-442-1773
Mailing Address - Fax:
Practice Address - Street 1:1205 SAINT CHARLES AVE APT 616
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-8408
Practice Address - Country:US
Practice Address - Phone:504-442-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2009-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist