Provider Demographics
NPI:1083840391
Name:BERNIS, SHELLEY ANNE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANNE
Last Name:BERNIS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 MANCHACA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5947
Mailing Address - Country:US
Mailing Address - Phone:512-444-3345
Mailing Address - Fax:512-444-3320
Practice Address - Street 1:3605 MANCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5947
Practice Address - Country:US
Practice Address - Phone:512-444-3345
Practice Address - Fax:512-444-3320
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist