Provider Demographics
NPI:1972930667
Name:CLEMENTS, SHELBY DANYELLE (BA)
Entity type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:DANYELLE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 LABETTE MANOR DR APT Y28
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7339
Mailing Address - Country:US
Mailing Address - Phone:501-554-4010
Mailing Address - Fax:
Practice Address - Street 1:2003 UNIVERSITY DR STE 2
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-2463
Practice Address - Country:US
Practice Address - Phone:870-671-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13-01342355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant