Provider Demographics
NPI:1265239768
Name:LEDGERWOOD, SHELBI
Entity type:Individual
Prefix:
First Name:SHELBI
Middle Name:
Last Name:LEDGERWOOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 FLETCHER LN
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-2053
Mailing Address - Country:US
Mailing Address - Phone:317-749-6890
Mailing Address - Fax:
Practice Address - Street 1:1643 DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-3915
Practice Address - Country:US
Practice Address - Phone:317-988-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012766A101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool