Provider Demographics
NPI:1134871742
Name:WOODRUM, SHELLBY LYNNE (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELLBY
Middle Name:LYNNE
Last Name:WOODRUM
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:SHELLBY
Other - Middle Name:LYNNE
Other - Last Name:MULLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:2301 BEMISS RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1934
Mailing Address - Country:US
Mailing Address - Phone:229-244-1667
Mailing Address - Fax:229-244-8253
Practice Address - Street 1:2301 BEMISS RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1934
Practice Address - Country:US
Practice Address - Phone:229-244-1667
Practice Address - Fax:229-244-8253
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist