Provider Demographics
NPI:1376804070
Name:CUSKADEN, SHELLEY MAY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MAY
Last Name:CUSKADEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:KATHERINE
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:522 CONCORD CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1912
Mailing Address - Country:US
Mailing Address - Phone:260-450-9690
Mailing Address - Fax:
Practice Address - Street 1:9745 OLYMPIA DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9226
Practice Address - Country:US
Practice Address - Phone:877-931-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005477A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist