Shelby Lynne Thelen, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7151013260 Issued in MI

Practice address

545 Lincoln Ave Ste 4
Winnetka, IL 60093-2349

Phone

(312) 780-0820

NPI assigned

Jun 18, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623974400000",
    "number": "1972172559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 44TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495094376",
            "telephone_number": "989-640-5275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 LINCOLN AVE STE 4",
            "city": "WINNETKA",
            "state": "IL",
            "postal_code": "600932349",
            "telephone_number": "312-780-0820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THELEN",
        "first_name": "SHELBY",
        "middle_name": "LYNNE",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-18",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7151013260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "thelens95@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "545 Lincoln Ave Ste 4",
            "city": "Winnetka",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600932349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Speech-Language Pathologist in Winnetka, IL
• Providers in Winnetka, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; 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.