Provider Demographics
NPI:1881257632
Name:REDFEARN, SHELBI
Entity type:Individual
Prefix:
First Name:SHELBI
Middle Name:
Last Name:REDFEARN
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 1:1401 EAGLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-3109
Mailing Address - Country:US
Mailing Address - Phone:405-334-2765
Mailing Address - Fax:
Practice Address - Street 1:1401 EAGLE LAKE RD
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3109
Practice Address - Country:US
Practice Address - Phone:979-885-2937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist