Provider Demographics
NPI:1811534951
Name:O'BANION, SHELBY JEAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:JEAN
Last Name:O'BANION
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:JEAN
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0206
Mailing Address - Country:US
Mailing Address - Phone:509-354-5900
Mailing Address - Fax:
Practice Address - Street 1:3737 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-5099
Practice Address - Country:US
Practice Address - Phone:509-354-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61003362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14180942OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION (ASHA)
WALL61003362OtherWA DEPARTMENT OF HEALTH