Provider Demographics
NPI:1376790634
Name:TRIBOULET, SHELLEY RAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:RAE
Last Name:TRIBOULET
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 1:1805 W CITY DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9633
Mailing Address - Country:US
Mailing Address - Phone:252-331-1375
Mailing Address - Fax:252-331-1376
Practice Address - Street 1:1805 W CITY DR
Practice Address - Street 2:SUITE G
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9633
Practice Address - Country:US
Practice Address - Phone:252-331-1375
Practice Address - Fax:252-331-1376
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist