Provider Demographics
NPI:1942627682
Name:ALLEN, SHELLY JANE (SLP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:JANE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16460 HIGHWAY 3
Mailing Address - Street 2:#1306
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-6212
Mailing Address - Country:US
Mailing Address - Phone:832-785-7173
Mailing Address - Fax:
Practice Address - Street 1:304 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4333
Practice Address - Country:US
Practice Address - Phone:281-534-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist