Provider Demographics
NPI:1154057156
Name:CORREALE, SHELBY RHEA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:RHEA
Last Name:CORREALE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76374-1832
Mailing Address - Country:US
Mailing Address - Phone:940-564-5614
Mailing Address - Fax:
Practice Address - Street 1:121 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:TX
Practice Address - Zip Code:76374-1832
Practice Address - Country:US
Practice Address - Phone:940-564-5614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist