Provider Demographics
NPI:1457178873
Name:SHIPLE, DEVIN MOORE
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:MOORE
Last Name:SHIPLE
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 1:1637 21ST RD N APT 10
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1153
Mailing Address - Country:US
Mailing Address - Phone:703-338-2023
Mailing Address - Fax:
Practice Address - Street 1:1768 BUSINESS CENTER DR STE 330
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4882
Practice Address - Country:US
Practice Address - Phone:703-679-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001498235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist