Provider Demographics
NPI:1346072014
Name:GRIZZLE, SHELBY MAY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:MAY
Last Name:GRIZZLE
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 1:580 W VIA DE PALMAS
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-8561
Mailing Address - Country:US
Mailing Address - Phone:480-489-4226
Mailing Address - Fax:
Practice Address - Street 1:12065 N 67TH AVE
Practice Address - Street 2:STE 122A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-525-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA154342355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant