Individual
SHELLY C. PATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MCD CCC-SLP
Contact information
Practice address
4117 RENEE DR, JONESBORO, AR 72404-8581
(870) 974-3718
Mailing address
4117 RENEE DR, JONESBORO, AR 72404-8581
(870) 974-3718
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP #1656
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149793721
—
AR
Enumeration date
05/14/2007
Last updated
07/09/2007
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