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General NPI Number Information
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NPI Number | 1104331248
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Entity Type | Individual
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Provider Name | KELLY SHENK M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 451 CHICAGO AVE
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City | HARRISONBURG
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State | VA
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Zip | 22802-2203
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Country | US
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Telephone | 540-434-8352
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Fax | 540-434-9996
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Provider Business Mailing Address
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Address Line | 451 CHICAGO AVE
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City | HARRISONBURG
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State | VA
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Zip | 22802-2203
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Country | US
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Telephone | 540-434-8352
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Fax | 540-434-9996
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202001509
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License Number State | VA
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