Provider Demographics
NPI:1619716727
Name:HOUSE, SHELLI JEAN
Entity type:Individual
Prefix:
First Name:SHELLI
Middle Name:JEAN
Last Name:HOUSE
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 1:201 D ST STE S
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5958
Mailing Address - Country:US
Mailing Address - Phone:530-565-0960
Mailing Address - Fax:
Practice Address - Street 1:201 D ST STE S
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5958
Practice Address - Country:US
Practice Address - Phone:530-565-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16197196727175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist