Provider Demographics
NPI:1619633393
Name:WILSON, SHELBY PAIGE (SLPA)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:PAIGE
Last Name:WILSON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:MISS
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:MOAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1701 EXCHANGE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-3020
Mailing Address - Country:US
Mailing Address - Phone:405-587-0430
Mailing Address - Fax:
Practice Address - Street 1:3101 LYON BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-587-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-21-157074106S00000X
OK3532355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician