Individual
SHELLY MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1612 S MAIN ST, HOLDEN, MO 64040-1685
(816) 258-2301
Mailing address
13701 E HARVEST LN, PECULIAR, MO 64078-9532
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TC
MO
Other
Enumeration date
03/02/2021
Last updated
03/02/2021
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