Provider Demographics
NPI:1922779628
Name:LANGLEY, SHELLEY ANN
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANN
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 E RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9161
Mailing Address - Country:US
Mailing Address - Phone:989-553-6513
Mailing Address - Fax:
Practice Address - Street 1:2875 E RICHARDSON RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9161
Practice Address - Country:US
Practice Address - Phone:989-553-6513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
MI251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No172V00000XOther Service ProvidersCommunity Health Worker