Provider Demographics
NPI:1306180294
Name:STORM, SHELBY LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:LYNN
Last Name:STORM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1711
Mailing Address - Country:US
Mailing Address - Phone:304-281-1889
Mailing Address - Fax:
Practice Address - Street 1:225 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1572
Practice Address - Country:US
Practice Address - Phone:304-455-2600
Practice Address - Fax:304-455-2580
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist