Provider Demographics
NPI:1346134673
Name:STEFFENSEN, SHELBY JANE
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:JANE
Last Name:STEFFENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 E BONNER WAY
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4917
Mailing Address - Country:US
Mailing Address - Phone:801-262-2908
Mailing Address - Fax:
Practice Address - Street 1:1205 E BONNER WAY
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84117-4917
Practice Address - Country:US
Practice Address - Phone:801-262-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14183519-4003225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist