Provider Demographics
NPI:1104332436
Name:SHELBY, BOBBI DENISE
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:DENISE
Last Name:SHELBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21543 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-1175
Mailing Address - Country:US
Mailing Address - Phone:815-582-0340
Mailing Address - Fax:
Practice Address - Street 1:11600 HERITAGE MEADOWS DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-2084
Practice Address - Country:US
Practice Address - Phone:815-254-4005
Practice Address - Fax:815-254-9706
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist