Provider Demographics
NPI:1235258674
Name:SHIRLEY, KELLEY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4778 OVERTON RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210-3803
Mailing Address - Country:US
Mailing Address - Phone:205-957-0294
Mailing Address - Fax:205-957-0298
Practice Address - Street 1:4778 OVERTON RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-3803
Practice Address - Country:US
Practice Address - Phone:205-957-0294
Practice Address - Fax:205-957-0298
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6288548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-35381OtherBCBS PROVIDER NUMBER