1194200246 NPI number — MRS. SHELBY DEE CLEAVINGER KING SLP

Table of content: MRS. SHELBY DEE CLEAVINGER KING SLP (NPI 1194200246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194200246 NPI number — MRS. SHELBY DEE CLEAVINGER KING SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
SHELBY
Provider Middle Name:
DEE CLEAVINGER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLEAVINGER
Provider Other First Name:
SHELBY
Provider Other Middle Name:
DEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194200246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 WEST WASHINGTON
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-739-2712
Provider Business Mailing Address Fax Number:
575-739-2705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 WEST WASHINGTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-739-2712
Provider Business Practice Location Address Fax Number:
575-739-2705
Provider Enumeration Date:
09/25/2018

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:  SLP6565 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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