Provider Demographics
NPI:1417260290
Name:SMITH, SHELLEY WETZEL (AU D)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:WETZEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 S CHISHOLM TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1402
Mailing Address - Country:US
Mailing Address - Phone:337-739-6211
Mailing Address - Fax:
Practice Address - Street 1:1528 COMMON ST STE 5
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3336
Practice Address - Country:US
Practice Address - Phone:830-643-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80221237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist