Provider Demographics
NPI:1629449251
Name:EDMONDSON, SHELBY K (MS CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:K
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 HIGHWAY 91 W
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9285
Mailing Address - Country:US
Mailing Address - Phone:870-932-8023
Mailing Address - Fax:870-932-9832
Practice Address - Street 1:1834 HIGHWAY 91 W
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9285
Practice Address - Country:US
Practice Address - Phone:870-932-8023
Practice Address - Fax:870-932-9832
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist