Kelli Shaw

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

TSLP-2657 Issued in ID

Practice address

3115 N Sycamore Dr
Boise, ID 83703-4129

Phone

(208) 401-6401

NPI assigned

Mar 18, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426636800000",
    "number": "1023401825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 N HILLVIEW DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837128120",
            "telephone_number": "208-353-7776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3115 N SYCAMORE DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837034129",
            "telephone_number": "208-401-6401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KELLI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-18",
        "last_updated": "2015-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "TSLP-2657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ashley Shaw, NBC-HWC
• Bradyn Michael Eugene Shaw, RN
• Marian E Shaw, MD
• Shaws Supermarkets Inc
• Amylia May Shayne, DNP, FNP
• Lauren Myer Shea, MD
• Amy J Sheaffer, MA, LMFT

• Speech-Language Pathologist in Boise, ID
• Providers in Boise, ID by specialty
• Speech-Language Pathologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.