Provider Demographics
NPI:1619299740
Name:SHELTON, BRANDIE HODGES (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:HODGES
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 WALNUT WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4389
Mailing Address - Country:US
Mailing Address - Phone:270-784-6796
Mailing Address - Fax:
Practice Address - Street 1:1403 WALNUT WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-4389
Practice Address - Country:US
Practice Address - Phone:270-784-6796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist