Provider Demographics
NPI:1720618093
Name:VALDIVIA, SHELLEY ANDERSON (SLP-A)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANDERSON
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5628 GOLD POPPY WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-2823
Mailing Address - Country:US
Mailing Address - Phone:916-261-3703
Mailing Address - Fax:
Practice Address - Street 1:195 GLEN COVE MARINA RD E STE 201
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7291
Practice Address - Country:US
Practice Address - Phone:707-651-9915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44302355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant