Basic Information
| Provider Information | |||||||||
| NPI: | 1376912808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIPLEY | ||||||||
| FirstName: | KAYLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2810 FRANK SCOTT PARKWAY WEST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622235007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182349705 | ||||||||
| FaxNumber: | 6182370665 | ||||||||
| Practice Location | |||||||||
| Address1: | 2810 FRANK SCOTT PARKWAY WEST | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622235007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182349705 | ||||||||
| FaxNumber: | 6182370665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2015 | ||||||||
| LastUpdateDate: | 09/15/2015 | ||||||||
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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 | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.