Individual
SHELLEY ANNE REICHELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
2307 PUEBLO DR, LAFAYETTE, IN 47909-2750
(765) 714-9870
Mailing address
2307 PUEBLO DR, LAFAYETTE, IN 47909-2750
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22005509A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001009924
ANTHEM PROVIDER NUMBER
IN
05
—
201353210
—
IN
Enumeration date
02/14/2013
Last updated
05/23/2016
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