Individual
KELLY SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
5219 88TH AVE, KENOSHA, WI 53144-7468
(262) 653-0850
Mailing address
14460 W HONEY LN, NEW BERLIN, WI 53151-2314
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3456-154
WI
Other
Enumeration date
07/03/2012
Last updated
07/03/2012
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