Provider Demographics
NPI:1467116541
Name:SHELTON, SHALEKO RAE (MS CCC,SLP)
Entity Type:Individual
Prefix:
First Name:SHALEKO
Middle Name:RAE
Last Name:SHELTON
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 1:115 WHITE TAIL DR
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-9248
Mailing Address - Country:US
Mailing Address - Phone:870-582-3072
Mailing Address - Fax:
Practice Address - Street 1:205 ISBELL
Practice Address - Street 2:
Practice Address - City:HORATIO
Practice Address - State:AR
Practice Address - Zip Code:71842-8834
Practice Address - Country:US
Practice Address - Phone:870-582-3072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP3133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist