Provider Demographics
NPI:1316014517
Name:PAULSON, SHELLEY D (MS CCC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:D
Last Name:PAULSON
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1811 RAINBOW BLVD SUITE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146
Mailing Address - Country:US
Mailing Address - Phone:702-641-8255
Mailing Address - Fax:702-399-8255
Practice Address - Street 1:5516 S FORT APACHE RD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7679
Practice Address - Country:US
Practice Address - Phone:702-641-8255
Practice Address - Fax:702-399-8255
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-91235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist