Individual
MRS. SHELLEY LYNN REVORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
1691 E US 23 STE 4, EAST TAWAS, MI 48730-9337
(989) 310-1962
Mailing address
900 N KOBS RD, TAWAS CITY, MI 48763-9762
(989) 310-1963
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101006633
MI
Other
Enumeration date
01/12/2021
Last updated
01/12/2021
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