Provider Demographics
NPI:1841913399
Name:SHELLY, TRACY ELAINE
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ELAINE
Last Name:SHELLY
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 1:9 SE 215TH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-7507
Mailing Address - Country:US
Mailing Address - Phone:660-909-5989
Mailing Address - Fax:
Practice Address - Street 1:5401 LANE AVE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-2740
Practice Address - Country:US
Practice Address - Phone:816-268-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist