Provider Demographics
NPI:1174808984
Name:LAMPE, SHELLEY
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:
Last Name:LAMPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10617 JEFFERSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRDALE
Mailing Address - State:KY
Mailing Address - Zip Code:40118-9042
Mailing Address - Country:US
Mailing Address - Phone:502-367-2368
Mailing Address - Fax:502-367-2368
Practice Address - Street 1:10617 JEFFERSON HILL RD
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:KY
Practice Address - Zip Code:40118-9042
Practice Address - Country:US
Practice Address - Phone:502-367-2368
Practice Address - Fax:502-367-2368
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist