Provider Demographics
NPI:1013496868
Name:SHEDRON, MARTI (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:
Last Name:SHEDRON
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 OAKGLEN ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-4372
Mailing Address - Country:US
Mailing Address - Phone:314-406-1158
Mailing Address - Fax:
Practice Address - Street 1:849 JEFFCO BLVD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-1409
Practice Address - Country:US
Practice Address - Phone:636-282-5184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist