Provider Demographics
NPI:1306615612
Name:BUNTON, SHELLEY LOUISE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LOUISE
Last Name:BUNTON
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 1:3005 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3761
Mailing Address - Country:US
Mailing Address - Phone:816-726-6701
Mailing Address - Fax:
Practice Address - Street 1:600 NW PRYOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1104
Practice Address - Country:US
Practice Address - Phone:816-347-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001031152235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist