Provider Demographics
NPI:1184240020
Name:CLUTTER, SHELBY CELINE
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:CELINE
Last Name:CLUTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W TAZEWELL ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1315
Mailing Address - Country:US
Mailing Address - Phone:703-209-8992
Mailing Address - Fax:
Practice Address - Street 1:23352 COURTHOUSE HWY
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VA
Practice Address - Zip Code:23487-5333
Practice Address - Country:US
Practice Address - Phone:703-209-8992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA22040000520OtherLICENSE