Provider Demographics
NPI:1013349240
Name:SHELINE, LAURA L (SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:SHELINE
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 1:415 CEDAR ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3927
Mailing Address - Country:US
Mailing Address - Phone:505-224-7020
Mailing Address - Fax:505-224-7023
Practice Address - Street 1:415 CEDAR ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3927
Practice Address - Country:US
Practice Address - Phone:505-224-7020
Practice Address - Fax:505-224-7023
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist