Provider Demographics
NPI:1932507498
Name:SHIELDS, FELICIA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:MARIE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5244 W RUNNING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1845
Mailing Address - Country:US
Mailing Address - Phone:410-707-4036
Mailing Address - Fax:
Practice Address - Street 1:10450 SHAKER DR
Practice Address - Street 2:SUITE 108
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1143
Practice Address - Country:US
Practice Address - Phone:410-707-4036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist