Individual
DR. SHELLIE DEE LOCKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
9020 15TH AVE, KENOSHA, WI 53143-6803
(708) 224-7442
Mailing address
9020 15TH AVE, KENOSHA, WI 53143-6803
(708) 224-7442
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
071.007310
IL
103G00000X
Clinical Neuropsychologist
2660-057
WI
103TC0700X
Clinical Psychologist
Primary
071.007310
IL
103TC0700X
Clinical Psychologist
2660-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40994300
—
WI
Enumeration date
03/11/2008
Last updated
03/11/2008
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