Provider Demographics
NPI:1760566244
Name:SHELTON, JENNIFER (ST)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 COUNTY ROAD 90
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4899
Mailing Address - Country:US
Mailing Address - Phone:713-436-8000
Mailing Address - Fax:713-436-8008
Practice Address - Street 1:2550 COUNTY ROAD 90
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4899
Practice Address - Country:US
Practice Address - Phone:713-436-8000
Practice Address - Fax:713-436-8008
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist