=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861382608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHELLY J FRANCIS MS CCC-SLP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2025
-----------------------------------------------------
Last Update Date | 07/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6266 EQUINE DR
-----------------------------------------------------
City | CRESTVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32536-4383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-318-0685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6266 EQUINE DR
-----------------------------------------------------
City | CRESTVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32536-4383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-318-0685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST/OWNER
-----------------------------------------------------
Name | SHELLY JEAN FRANCIS
-----------------------------------------------------
Credential | MS CCC-SLP
-----------------------------------------------------
Telephone | 618-318-0685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------