Provider Demographics
NPI:1770775223
Name:NASER, SHELLY RAE (MA/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:RAE
Last Name:NASER
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 1:3900 S CATHY AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-1518
Mailing Address - Country:US
Mailing Address - Phone:605-361-8822
Mailing Address - Fax:
Practice Address - Street 1:3900 S CATHY AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-1518
Practice Address - Country:US
Practice Address - Phone:605-361-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD12035672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist