Provider Demographics
NPI:1215097662
Name:MCALLUM, SHELBY (SLP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MCALLUM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 VAUGHN DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5117
Mailing Address - Country:US
Mailing Address - Phone:817-426-0494
Mailing Address - Fax:
Practice Address - Street 1:1052 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-4558
Practice Address - Country:US
Practice Address - Phone:254-965-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003593302Medicaid
TX8465LCOtherBLUE CROSS BLUE SHIELD