Provider Demographics
NPI:1972045482
Name:VANDERVEEN, SHELBY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:VANDERVEEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54876 852 RD
Mailing Address - Street 2:
Mailing Address - City:PIERCE
Mailing Address - State:NE
Mailing Address - Zip Code:68767-3505
Mailing Address - Country:US
Mailing Address - Phone:712-202-3806
Mailing Address - Fax:
Practice Address - Street 1:110 W 3RD ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1464
Practice Address - Country:US
Practice Address - Phone:402-887-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2016008405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist