Provider Demographics
NPI:1447063789
Name:CHITTY, SHELLEY YATES (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:YATES
Last Name:CHITTY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BORDEN
Mailing Address - State:IN
Mailing Address - Zip Code:47106-8511
Mailing Address - Country:US
Mailing Address - Phone:419-709-1456
Mailing Address - Fax:
Practice Address - Street 1:2525 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2556
Practice Address - Country:US
Practice Address - Phone:812-542-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007179A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist