Provider Demographics
NPI:1912243874
Name:SHELATO, JENNIFER LEIGH (CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:SHELATO
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:BRESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:946 AVONLEY CREEK TRCE
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1006
Mailing Address - Country:US
Mailing Address - Phone:443-375-2077
Mailing Address - Fax:
Practice Address - Street 1:4500 SATELLITE BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5037
Practice Address - Country:US
Practice Address - Phone:800-381-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist