Shelley Lynn Revord, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · East Tawas, MI
NPI 1215526587 · NPPES record last updated Jan 12, 2021
Key facts
- NPI
- 1215526587
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 7101006633 (MI)
- Practice address
- 1691 E US 23 Ste 4
East Tawas, MI 48730-9337 - Phone
- (989) 310-1962
- NPI assigned
- Jan 12, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 7101006633 | MI | Yes |
Addresses
Primary practice location
1691 E US 23 Ste 4
East Tawas, MI 48730-9337
Mailing address
900 N Kobs Rd
Tawas City, MI 48763-9762
Phone (989) 310-1963
Other providers in East Tawas, MI
- Anna-Marie Elizabeth Pike
- Erin Renee Porteous
- Sabrina Maria Prescott
- Cathy Pruder
- Retirement Living Management of Tawas LLC
- Richard P. Payea, M.D., PC
- Gretchen M Ross
- Gloria Jean Rouleau-Gerber
- Crystal Angela Ruemenapp
- Kristen Lois Runyan
All providers in East Tawas, MI · Speech-Language Pathologist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.