Provider Demographics
NPI:1255001368
Name:HENSLEY, SHELBY (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHARLES CROSS WAY UNIT 7111
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9397
Mailing Address - Country:US
Mailing Address - Phone:405-315-5185
Mailing Address - Fax:843-379-5338
Practice Address - Street 1:250 JAGUAR TRL
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-5580
Practice Address - Country:US
Practice Address - Phone:803-814-4054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7347235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7347OtherSLP LICENSE