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General NPI Number Information
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NPI Number | 1750435897
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Entity Type | Individual
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Provider Name | SHELLY NIELSON MA
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1084 W. SAN TAN HILLS
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City | QUEEN CREEK
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State | AZ
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Zip | 85242
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Country | US
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Telephone | 480-888-7515
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Fax | 480-655-6137
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Provider Business Mailing Address
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Address Line | 3291 E HAMPTON LN
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City | GILBERT
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State | AZ
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Zip | 85297-6522
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Country | US
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Telephone | 480-659-9799
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Fax |
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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 | SLP1787
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License Number State | AZ
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