Provider Demographics
NPI:1346768751
Name:LOWRY, SHAE NICOLE
Entity type:Individual
Prefix:
First Name:SHAE
Middle Name:NICOLE
Last Name:LOWRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHAE
Other - Middle Name:NICOLE
Other - Last Name:EBLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 S 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-1615
Mailing Address - Country:US
Mailing Address - Phone:618-315-9601
Mailing Address - Fax:
Practice Address - Street 1:634 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3746
Practice Address - Country:US
Practice Address - Phone:618-315-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146014142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist