Provider Demographics
NPI:1831643667
Name:SHELTON, JULIE VESPIE (MA, IECE)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:VESPIE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MA, IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PICKETT RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9727
Mailing Address - Country:US
Mailing Address - Phone:270-339-0895
Mailing Address - Fax:
Practice Address - Street 1:200 PICKETT RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9727
Practice Address - Country:US
Practice Address - Phone:270-339-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
KY201135158222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist