Provider Demographics
NPI:1780857532
Name:SHOULTS, SHARON MARIE (MS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:SHOULTS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:SHOULTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 385A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8214
Mailing Address - Country:US
Mailing Address - Phone:314-251-5850
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 385A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8214
Practice Address - Country:US
Practice Address - Phone:314-251-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000162142231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist