Provider Demographics
NPI:1649897695
Name:WIER, SHELLY BETH (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:BETH
Last Name:WIER
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 1:2545 LITTLE CANEY DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8920
Mailing Address - Country:US
Mailing Address - Phone:501-339-7551
Mailing Address - Fax:
Practice Address - Street 1:2545 LITTLE CANEY DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-8920
Practice Address - Country:US
Practice Address - Phone:501-339-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist