Shelley Landry
Individual provider Active NPI Speech-Language Pathologist · Vidor, TX
NPI 1992230148 · NPPES record last updated Aug 14, 2019
Key facts
- NPI
- 1992230148
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 113485 (TX)
- Practice address
- 500 South St Ste 300
Vidor, TX 77662-6183 - Phone
- (409) 498-4066
- NPI assigned
- Apr 25, 2017
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201201002332 | TX | Practitioner - Qualified Speech Language Pathologist | 9931510690 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113485 | TX | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kids Therapy Set, LLC | Speech-Language Pathologist | Current |
Accepting new patients |
Locations
4900 Sanger Ave
Waco, TX 76710
Phone (254) 644-2423
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 113485 | TX | Yes |
Addresses
Primary practice location
500 South St Ste 300
Vidor, TX 77662-6183
Mailing address
305 NE Loop 820
Business Tower 1, Suite 200
Hurst, TX 76053-7209
Phone (817) 292-8787
Other practice location 1
87 Interstate 10 N
Suite 225
Beaumont, TX 77707-2544
Phone (409) 835-0228
Other providers in Vidor, TX
- Matilda Denise Kelley
- Kelley'S Karing Touch, LLC
- Kids Therapy Set, LLC
- Melvin Kohn
- Jennie Lam
- Jerry Dwayne Leavins
- Morgan Nicole Lewallen
- Liberty County Hospital District No. 1
- Taryn Danee Light
- Barbara Chyenne Loftin
All providers in Vidor, TX · Speech-Language Pathologist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.