Provider Demographics
NPI:1861501983
Name:SHELL, LIBBIE L (AUD)
Entity Type:Individual
Prefix:MRS
First Name:LIBBIE
Middle Name:L
Last Name:SHELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1892
Mailing Address - Country:US
Mailing Address - Phone:360-671-7530
Mailing Address - Fax:
Practice Address - Street 1:2940 SQUALICUM PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1892
Practice Address - Country:US
Practice Address - Phone:360-671-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00002648231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8373466Medicaid
WA8373466Medicaid