Provider Demographics
NPI:1831457902
Name:ASHBOCKER, SHELLY RAE (SLP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:RAE
Last Name:ASHBOCKER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-8701
Mailing Address - Country:US
Mailing Address - Phone:208-390-1139
Mailing Address - Fax:
Practice Address - Street 1:147 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-8701
Practice Address - Country:US
Practice Address - Phone:208-390-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist