Provider Demographics
NPI:1992328389
Name:MOSEBY, SHELBY RENAE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:RENAE
Last Name:MOSEBY
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 1:1301 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-3017
Mailing Address - Country:US
Mailing Address - Phone:918-855-5338
Mailing Address - Fax:
Practice Address - Street 1:10310 N 138TH EAST AVE STE 101
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4611
Practice Address - Country:US
Practice Address - Phone:918-855-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200907480AMedicaid