Provider Demographics
NPI:1780217539
Name:SPOONER, SHELLY F (STA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:F
Last Name:SPOONER
Suffix:
Gender:F
Credentials:STA
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STA
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-474-5121
Mailing Address - Fax:207-474-9261
Practice Address - Street 1:57 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1414
Practice Address - Country:US
Practice Address - Phone:207-474-7000
Practice Address - Fax:207-858-4772
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESAS23522355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant