Healthcare Provider Details

I. General information

NPI: 1467116541
Provider Name (Legal Business Name): SHALEKO RAE SHELTON M.S. CCC,SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ISBELL
HORATIO AR
71842-8834
US

IV. Provider business mailing address

115 WHITE TAIL DR
DE QUEEN AR
71832-9248
US

V. Phone/Fax

Practice location:
  • Phone: 870-582-3072
  • Fax:
Mailing address:
  • Phone: 870-582-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP3133
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: