Provider Demographics
NPI:1215255708
Name:HORTMAN, SHELLEY TUCKER (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:TUCKER
Last Name:HORTMAN
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 1:15949 HIGHWAY 105 W
Mailing Address - Street 2:STE 52 A
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5738
Mailing Address - Country:US
Mailing Address - Phone:936-588-5008
Mailing Address - Fax:936-588-1011
Practice Address - Street 1:15949 HIGHWAY 105 W
Practice Address - Street 2:STE 52 A
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5738
Practice Address - Country:US
Practice Address - Phone:936-588-5008
Practice Address - Fax:936-588-1011
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist