Provider Demographics
NPI:1942544069
Name:LATHAM, SHELBY NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:NICOLE
Last Name:LATHAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1708
Mailing Address - Country:US
Mailing Address - Phone:270-977-6707
Mailing Address - Fax:
Practice Address - Street 1:102 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1708
Practice Address - Country:US
Practice Address - Phone:270-977-6707
Practice Address - Fax:270-713-1718
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4123235Z00000X
KY142307235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist