Provider Demographics
NPI:1679119887
Name:FOSSEN, SHELLEY ANN (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANN
Last Name:FOSSEN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:ANN
Other - Last Name:SIME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4272
Mailing Address - Country:US
Mailing Address - Phone:701-252-3376
Mailing Address - Fax:
Practice Address - Street 1:207 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4272
Practice Address - Country:US
Practice Address - Phone:701-252-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND49572355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant