1093531501 NPI number — SHELBY ELIZABETH RICHWINE MA, CCC-SLP

Table of content: SHELBY ELIZABETH RICHWINE MA, CCC-SLP (NPI 1093531501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093531501 NPI number — SHELBY ELIZABETH RICHWINE MA, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHWINE
Provider First Name:
SHELBY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093531501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5801 ALPINE HEIGHTS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORROW
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45152-3519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-226-5897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7139 CANTERWOOD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAINEVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45039-7016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-757-0923
Provider Business Practice Location Address Fax Number:
513-713-0323
Provider Enumeration Date:
11/29/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP.13774 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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