Provider Demographics
NPI:1093304495
Name:HOLSAPPLE, SHELBY LYNNE
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNNE
Last Name:HOLSAPPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 BOWFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-6812
Mailing Address - Country:US
Mailing Address - Phone:309-265-2874
Mailing Address - Fax:
Practice Address - Street 1:502 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:IN
Practice Address - Zip Code:46058-9538
Practice Address - Country:US
Practice Address - Phone:765-296-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007385A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist