Provider Demographics
NPI:1780856864
Name:RUE, SHELLEY WITHERS
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:WITHERS
Last Name:RUE
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 1:343 WALLER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2912
Mailing Address - Country:US
Mailing Address - Phone:859-806-9504
Mailing Address - Fax:859-272-6893
Practice Address - Street 1:343 WALLER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2912
Practice Address - Country:US
Practice Address - Phone:859-806-9504
Practice Address - Fax:859-272-6893
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator