Provider Demographics
NPI:1851591945
Name:IBBETSON, SHAELENE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHAELENE
Middle Name:
Last Name:IBBETSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 CALIFORNIA AVE SW APT 608
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1292
Mailing Address - Country:US
Mailing Address - Phone:206-793-8350
Mailing Address - Fax:
Practice Address - Street 1:5001 CALIFORNIA AVE SW APT 608
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1292
Practice Address - Country:US
Practice Address - Phone:206-938-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist