Provider Demographics
NPI:1356877419
Name:STAVELY, SHELBY LENAE (CCC/SLP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LENAE
Last Name:STAVELY
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 S CANOSA CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-4268
Mailing Address - Country:US
Mailing Address - Phone:918-774-7617
Mailing Address - Fax:
Practice Address - Street 1:1209 S CANOSA CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-4268
Practice Address - Country:US
Practice Address - Phone:918-774-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist