Healthcare Provider Details

I. General information

NPI: 1467376996
Provider Name (Legal Business Name): SHELLY NYSTROM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLY MCGEE CCC-SLP

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 3RD AVE STE 208
HAVRE MT
59501-3577
US

IV. Provider business mailing address

4091 9TH ST W
HAVRE MT
59501-6814
US

V. Phone/Fax

Practice location:
  • Phone: 406-344-8080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPRD-SP-LIC-844
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: