Provider Demographics
NPI:1427825603
Name:MCCARTHY, SHELLY LYN (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYN
Last Name:MCCARTHY
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 1:1615 ILLINGWORTH DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-6095
Mailing Address - Country:US
Mailing Address - Phone:724-991-4910
Mailing Address - Fax:
Practice Address - Street 1:1025 9TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4039
Practice Address - Country:US
Practice Address - Phone:970-348-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist