Provider Demographics
NPI:1407021983
Name:MARLEY, SHELLY LYNN (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:LYNN
Last Name:MARLEY
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 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:304-298-3602
Mailing Address - Fax:304-298-4597
Practice Address - Street 1:101 E. STATE ST
Practice Address - Street 2:
Practice Address - City:KENNET SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3109
Practice Address - Country:US
Practice Address - Phone:304-298-3602
Practice Address - Fax:304-298-4597
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1069235Z00000X
MD05785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD186300200Medicaid
MD186300200Medicaid
WV516524Medicare Oscar/Certification