Provider Demographics
NPI:1568835023
Name:MALONE, SHELLEY ANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANNE
Last Name:MALONE
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:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:OK
Mailing Address - Zip Code:73541-0285
Mailing Address - Country:US
Mailing Address - Phone:580-917-0992
Mailing Address - Fax:
Practice Address - Street 1:753NW FT SILL BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73502-1009
Practice Address - Country:US
Practice Address - Phone:580-353-0334
Practice Address - Fax:580-585-6350
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2549235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist