Provider Demographics
NPI:1154956266
Name:BARLOW, SHELLIE A ANN
Entity type:Individual
Prefix:
First Name:SHELLIE A
Middle Name:ANN
Last Name:BARLOW
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 1:3838 N CHARLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4795
Mailing Address - Country:US
Mailing Address - Phone:619-772-0772
Mailing Address - Fax:
Practice Address - Street 1:3838 N CHARLEVILLE RD
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4795
Practice Address - Country:US
Practice Address - Phone:619-772-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID200570018Medicaid