Provider Demographics
NPI:1629837307
Name:ZIMMERMAN, SHELBY LEIGH
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:LEIGH
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 NW CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:APACHE
Mailing Address - State:OK
Mailing Address - Zip Code:73006-8214
Mailing Address - Country:US
Mailing Address - Phone:580-512-9894
Mailing Address - Fax:
Practice Address - Street 1:9201 STATE HIGHWAY 17 STE F
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538-4517
Practice Address - Country:US
Practice Address - Phone:580-454-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QP2000X2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant