Provider Demographics
NPI:1629568456
Name:SHELTON, COLLEEN ROOME (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ROOME
Last Name:SHELTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EDGEVALE RD APT 2B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2268
Mailing Address - Country:US
Mailing Address - Phone:410-908-8082
Mailing Address - Fax:
Practice Address - Street 1:7400 YORK RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7531
Practice Address - Country:US
Practice Address - Phone:410-908-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist