Physician Compare National (NPI:1447643325)

HEALTHCARE PROVIDER: SHELLY MARIE LUTTMAN PHELPS LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1447643325
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5193031714
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150827001718
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PHELPS
	Individual professional last name
Provider First Name	SHELLY
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	14636 REESE BLVD W
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B3
	Group Practice or individual's line 2 address
City	HUNTERSVILLE
	Group Practice or individual's city
State	NC
	Group Practice or individual's state
Zip Code	280787956
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y