Individual
SHELLY ANN WITMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1202 S RIDGE DR, MANDEVILLE, LA 70448-1017
(504) 235-5006
Mailing address
1202 S RIDGE DR, MANDEVILLE, LA 70448-1017
(504) 235-5006
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4837
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12029919
ASHA CERTIFICATION
—
01
—
4837
STATE LIC.
LA
Enumeration date
03/08/2007
Last updated
07/08/2007
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