MEDICARE: MRS. SHELBIE B WILSON 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	3108	AL

General Provider Information

NPI Number	:	1871875245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELBIE B WILSON CCC-SLP

Provider Business Mailing Address
First Line	:	1528 BRIDGEWATER LN
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-4413
Country	:	US
Telephone Number	:	205-396-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	4231 DOLLY RIDGE RD
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5703
Country	:	US
Telephone Number	:	205-531-8998
Fax Number	:

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

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	09/12/2011

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