Basic Information
| Provider Information | |||||||||
| NPI: | 1316055171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRCHENBAUM | ||||||||
| FirstName: | SHELLEY | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7271 SARIMENTO PL | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334464413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613810905 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CLINIC FOR SPEECH-LANGUAGE & COMMUNICATION DISORDERS | ||||||||
| Address2: | 3301 COLLEGE AVENUE | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333144416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542627746 | ||||||||
| FaxNumber: | 9542622847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA2485 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.