Provider Demographics
NPI:1194200246
Name:KING, SHELBY DEE CLEAVINGER (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:DEE CLEAVINGER
Last Name:KING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:DEE
Other - Last Name:CLEAVINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 WEST WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260
Mailing Address - Country:US
Mailing Address - Phone:575-739-2712
Mailing Address - Fax:575-739-2705
Practice Address - Street 1:18 WEST WASHINGTON
Practice Address - Street 2:
Practice Address - City:LOVINGTON
Practice Address - State:NM
Practice Address - Zip Code:88260
Practice Address - Country:US
Practice Address - Phone:575-739-2712
Practice Address - Fax:575-739-2705
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP6565235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist