Provider Demographics
NPI:1417486580
Name:HEATH, SHELLEY (AUD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 AMBERLEY WAY STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8979
Mailing Address - Country:US
Mailing Address - Phone:859-623-4458
Mailing Address - Fax:859-623-4459
Practice Address - Street 1:1036 AMBERLEY WAY STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8979
Practice Address - Country:US
Practice Address - Phone:859-623-4458
Practice Address - Fax:859-623-4459
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173079231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist