Provider Demographics
NPI:1699816454
Name:PACKARD, SHEILA
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:
Last Name:PACKARD
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 1:500 FORUM DR
Mailing Address - Street 2:A
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-4602
Mailing Address - Country:US
Mailing Address - Phone:573-458-0100
Mailing Address - Fax:573-458-0105
Practice Address - Street 1:500 FORUM DR
Practice Address - Street 2:A
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4602
Practice Address - Country:US
Practice Address - Phone:573-458-0100
Practice Address - Fax:573-458-0105
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004029827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist