Active NPI
Shelly Lynn Marley, M.S., CCC/SLP
- Speech-Language Pathologist
- Kennet Square, PA
National Provider Identifier
1407021983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 05785
- Practice address
- 101 E. State St
Kennet Square, PA 19348-3109 - Phone
- (304) 298-3602
- Fax
- (304) 298-4597
- NPI assigned
- Apr 25, 2008
- Last updated
- Nov 3, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 1069 | WV | |
| Speech-Language Pathologist | 235Z00000X | 05785 | MD | Primary |
Addresses
Primary practice location
101 E. State St
Kennet Square, PA 19348-3109
Mailing address
101 E State St
Kennett Square, PA 19348-3109
Phone (304) 298-3602
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 186300200 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1069 | WV | MD | Mental Health Counselor |
| 05785 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320278400000",
"number": "1407021983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 E STATE ST",
"city": "KENNETT SQUARE",
"state": "PA",
"postal_code": "193483109",
"telephone_number": "304-298-3602",
"fax_number": "304-298-4597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E. STATE ST",
"city": "KENNET SQUARE",
"state": "PA",
"postal_code": "193483109",
"telephone_number": "304-298-3602",
"fax_number": "304-298-4597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARLEY",
"first_name": "SHELLY",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "M.S., CCC/SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-25",
"last_updated": "2011-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WV",
"license": "1069",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "05785",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "186300200",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennet Square, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.