Healthcare Provider Details

I. General information

NPI: 1790908598
Provider Name (Legal Business Name): SHELLEY D ZEPP MACCCSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3057 LORNA RD SUITE 220
BIRMINGHAM AL
35216-4514
US

IV. Provider business mailing address

3057 LORNA RD SUITE 220
BIRMINGHAM AL
35216-4514
US

V. Phone/Fax

Practice location:
  • Phone: 205-978-9939
  • Fax:
Mailing address:
  • Phone: 205-978-9939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP006290
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3998
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: