Provider Demographics
NPI:1376827204
Name:HANDREN, SHELLEY ANN (MA, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:ANN
Last Name:HANDREN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17880 DUNBLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4114
Mailing Address - Country:US
Mailing Address - Phone:248-821-7264
Mailing Address - Fax:
Practice Address - Street 1:25865 W 12 MILE RD
Practice Address - Street 2:104
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1817
Practice Address - Country:US
Practice Address - Phone:248-208-7492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1058923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist