Provider Demographics
NPI:1649612490
Name:NELSON, SHELLY L (MS, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S BUREAU VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-2203
Mailing Address - Country:US
Mailing Address - Phone:815-872-0023
Mailing Address - Fax:815-872-0023
Practice Address - Street 1:515 S BUREAU VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-2203
Practice Address - Country:US
Practice Address - Phone:815-872-0023
Practice Address - Fax:815-872-0023
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist