Provider Demographics
NPI:1528401171
Name:SMITH, SHELLY J (MA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 OFFICE PARK RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2549
Mailing Address - Country:US
Mailing Address - Phone:515-327-9111
Mailing Address - Fax:
Practice Address - Street 1:950 OFFICE PARK RD
Practice Address - Street 2:SUITE 121
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2549
Practice Address - Country:US
Practice Address - Phone:515-327-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-14
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist