Provider Demographics
NPI:1144418237
Name:SHIDELER, ANN M (MS)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:SHIDELER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 E UNION HILLS DR
Mailing Address - Street 2:#2087
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3363
Mailing Address - Country:US
Mailing Address - Phone:602-882-4964
Mailing Address - Fax:
Practice Address - Street 1:4750 E UNION HILLS DR
Practice Address - Street 2:#2087
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3363
Practice Address - Country:US
Practice Address - Phone:602-882-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist