Healthcare Provider Details

I. General information

NPI: 1659287647
Provider Name (Legal Business Name): SHELBY L WHITFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 SPRINGDALE STREET APT 215
MOUNT HOREB WI
53572
US

IV. Provider business mailing address

1881 SPRINGDALE STREET APT 215
MOUNT HOREB WI
53572
US

V. Phone/Fax

Practice location:
  • Phone: 608-574-2135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14315397
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: