Provider Demographics
NPI:1487990800
Name:DEROUEN, SHELLIE D (CCC-A)
Entity type:Individual
Prefix:MS
First Name:SHELLIE
Middle Name:D
Last Name:DEROUEN
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:SHELLIE
Other - Middle Name:D
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:378 WYNNPAGE DR
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-2106
Mailing Address - Country:US
Mailing Address - Phone:806-535-2053
Mailing Address - Fax:
Practice Address - Street 1:378 WYNNPAGE DR
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-2106
Practice Address - Country:US
Practice Address - Phone:806-535-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51478231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist