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NPI Code Detail

MEDICARE: SHELLY LICCIARDI SLP

MEDICARE: SHELLY LICCIARDI SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist11341CA

General Provider Information

NPI Number : 1407394711
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLY LICCIARDI SLP
Provider Business Mailing Address
First Line : 360 SAGE ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-6803
Country : US
Telephone Number : 805-234-2614
Fax Number :
Provider Business Practice Location Address
First Line : 1500 LIZZIE ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-3062
Country : US
Telephone Number : 805-596-4040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2017
Last Update Date : 05/04/2026

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Directions to “ SHELLY LICCIARDI SLP” Practice Location

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