Provider Demographics
NPI:1639647233
Name:SHAPLEY, KATHY LYNN (PHD CCC-SLP)
Entity Type:Individual
Prefix:PROF
First Name:KATHY
Middle Name:LYNN
Last Name:SHAPLEY
Suffix:
Gender:F
Credentials:PHD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 COLLEGE ST
Mailing Address - Street 2:MUW 1340
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-5800
Mailing Address - Country:US
Mailing Address - Phone:662-329-7272
Mailing Address - Fax:662-329-7460
Practice Address - Street 1:1100 COLLEGE ST
Practice Address - Street 2:MUW 1340
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-5800
Practice Address - Country:US
Practice Address - Phone:662-329-7272
Practice Address - Fax:662-329-7460
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112159235Z00000X
NC11748235Z00000X
MSS4485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist