Provider Demographics
NPI:1508058488
Name:EBERHARDT, SHELLEY ANNE (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANNE
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MISS
Other - First Name:SHELLEY
Other - Middle Name:ANNE
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:2400 COLUMBIA RD
Mailing Address - Street 2:LIFE CARE CENTER OF MEDINA
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9414
Mailing Address - Country:US
Mailing Address - Phone:330-483-3131
Mailing Address - Fax:330-483-3132
Practice Address - Street 1:2400 COLUMBIA RD
Practice Address - Street 2:LIFE CARE CENTER OF MEDINA
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9414
Practice Address - Country:US
Practice Address - Phone:330-483-3131
Practice Address - Fax:330-483-3132
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist