Provider Demographics
NPI:1417217316
Name:WOOLSTENHULME, SHELBY DEE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:DEE
Last Name:WOOLSTENHULME
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 1:3883 E. ASH LN.
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442
Mailing Address - Country:US
Mailing Address - Phone:208-390-1778
Mailing Address - Fax:
Practice Address - Street 1:450 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440
Practice Address - Country:US
Practice Address - Phone:208-356-6532
Practice Address - Fax:208-359-6574
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP2206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist