Provider Demographics
NPI:1164615365
Name:TENNYSON, SHELLEY D
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:D
Last Name:TENNYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:D
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-7044
Mailing Address - Country:US
Mailing Address - Phone:816-690-4156
Mailing Address - Fax:816-690-3031
Practice Address - Street 1:1305 SALEM ST
Practice Address - Street 2:OAK GROVE R-6 SCHOOL DISTRICT
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-7044
Practice Address - Country:US
Practice Address - Phone:816-690-4156
Practice Address - Fax:816-690-3031
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist