Provider Demographics
NPI:1407292121
Name:CHILTON, SHELLEY KERMEEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:KERMEEN
Last Name:CHILTON
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 1:95 W MAIN ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2487
Mailing Address - Country:US
Mailing Address - Phone:908-879-7067
Mailing Address - Fax:908-879-4117
Practice Address - Street 1:95 W MAIN ST
Practice Address - Street 2:SUITE 18
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2487
Practice Address - Country:US
Practice Address - Phone:908-879-7067
Practice Address - Fax:908-879-4117
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00231900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist