Basic Information
| Provider Information | |||||||||
| NPI: | 1356643886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRITZ | ||||||||
| FirstName: | SHELBY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.A. CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 N WABASH RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469521300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656513229 | ||||||||
| FaxNumber: | 7656513227 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 N WABASH RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469521300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656513229 | ||||||||
| FaxNumber: | 7656513227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2010 | ||||||||
| LastUpdateDate: | 12/05/2010 | ||||||||
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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 | 46002046A | IN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.