Provider Demographics
NPI:1700020039
Name:BODENSTEINER, SHELLY AMBER (MA CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:AMBER
Last Name:BODENSTEINER
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 W 47 HWY
Mailing Address - Street 2:PO BOX 189
Mailing Address - City:GIRARD
Mailing Address - State:KS
Mailing Address - Zip Code:66743-2347
Mailing Address - Country:US
Mailing Address - Phone:620-724-6281
Mailing Address - Fax:620-724-7243
Practice Address - Street 1:947 W 47 HWY
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:KS
Practice Address - Zip Code:66743-2347
Practice Address - Country:US
Practice Address - Phone:620-724-6281
Practice Address - Fax:620-724-7243
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1954231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist