Provider Demographics
NPI:1699418608
Name:HURTADO, SHELLEY JO (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:JO
Last Name:HURTADO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18702 NE 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-6115
Mailing Address - Country:US
Mailing Address - Phone:253-988-4900
Mailing Address - Fax:
Practice Address - Street 1:1946 8TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4044
Practice Address - Country:US
Practice Address - Phone:360-261-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61206787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist