MEDICARE: ALLISON MARIE SHELTON CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	8242643-4102	UT

General Provider Information

NPI Number	:	1457062895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON MARIE SHELTON CCC-SLP

Provider Business Mailing Address
First Line	:	2373 E 8100 S
Second Line	:
City	:	SOUTH WEBER
State	:	UT
Zip	:	84405-9486
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	552 CUTLER DR
Second Line	:
City	:	NORTH SALT LAKE
State	:	UT
Zip	:	84054-2953
Country	:	US
Telephone Number	:	801-936-0318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	12/07/2022

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