Provider Demographics
NPI:1851675466
Name:ANDERSON, SHELBY N (SLP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:N
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:N
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:600 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3425
Mailing Address - Country:US
Mailing Address - Phone:469-856-6000
Mailing Address - Fax:
Practice Address - Street 1:600 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3425
Practice Address - Country:US
Practice Address - Phone:469-856-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006412235Z00000X
TX108140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist