Provider Demographics
NPI:1437662897
Name:KING, SHELLEY RENE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENE
Last Name:KING
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:RENE
Other - Last Name:SEDLACEK-GRAUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:305 NE LOOP 820, BUSINESS TOWER 1
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:5225 SOUTH LOOPE 289
Practice Address - Street 2:STE 210
Practice Address - City:LUBBOCK
Practice Address - State:TN
Practice Address - Zip Code:79424-1319
Practice Address - Country:US
Practice Address - Phone:806-780-4180
Practice Address - Fax:806-744-7458
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist