Provider Demographics
NPI:1356702070
Name:SHIVELY, PHILIP
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:SHIVELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-1433
Mailing Address - Country:US
Mailing Address - Phone:402-694-2820
Mailing Address - Fax:
Practice Address - Street 1:300 L ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-1902
Practice Address - Country:US
Practice Address - Phone:402-694-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist