MEDICARE: SARAH SHELQUIST

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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1700048386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH SHELQUIST

Provider Business Mailing Address
First Line	:	2905 AURORA AVE
Second Line	:	NUMBER 104
City	:	BOULDER
State	:	CO
Zip	:	80303-2253
Country	:	US
Telephone Number	:	720-352-5304
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 AURORA AVE
Second Line	:	NUMBER 104
City	:	BOULDER
State	:	CO
Zip	:	80303-2253
Country	:	US
Telephone Number	:	720-352-5304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	06/25/2008

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Directions to “ SARAH SHELQUIST ” Practice Location

Language	Start Address	Practice Location

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