Provider Demographics
NPI:1952681942
Name:SHELTON SPEECH LANGUAGE HEARING CLINIC
Entity Type:Organization
Organization Name:SHELTON SPEECH LANGUAGE HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:972-774-1772
Mailing Address - Street 1:15720 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4161
Mailing Address - Country:US
Mailing Address - Phone:972-774-1772
Mailing Address - Fax:972-720-8217
Practice Address - Street 1:15720 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4161
Practice Address - Country:US
Practice Address - Phone:972-774-1772
Practice Address - Fax:972-720-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty