Provider Demographics
NPI:1922176106
Name:SLAP SHELTON, LAURA (PSYD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SLAP SHELTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WEST COLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-283-9377
Mailing Address - Fax:207-282-5895
Practice Address - Street 1:28 WEST COLE ROAD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005
Practice Address - Country:US
Practice Address - Phone:207-283-9377
Practice Address - Fax:207-282-5895
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS980103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134670000Medicaid
ME134670001Medicaid
ME134670001Medicaid