Provider Demographics
NPI:1710476262
Name:SHACKELFORD, ANNE RUSHTON (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:RUSHTON
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400270
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22904-4270
Mailing Address - Country:US
Mailing Address - Phone:434-924-8750
Mailing Address - Fax:434-924-4621
Practice Address - Street 1:417 EMMET ST S
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2424
Practice Address - Country:US
Practice Address - Phone:434-924-8750
Practice Address - Fax:434-924-4621
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist