Provider Demographics
NPI:1780160952
Name:STARKS, SHELBY K (SLP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:K
Last Name:STARKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-3505
Mailing Address - Country:US
Mailing Address - Phone:620-450-6607
Mailing Address - Fax:
Practice Address - Street 1:70240 S 336 RD
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-8642
Practice Address - Country:US
Practice Address - Phone:620-450-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5359235Z00000X
OK4942235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist