Provider Demographics
NPI:1154594604
Name:SHELTON, CARLA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1918
Mailing Address - Country:US
Mailing Address - Phone:304-768-4866
Mailing Address - Fax:
Practice Address - Street 1:928 GLEN WAY
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1918
Practice Address - Country:US
Practice Address - Phone:304-768-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist