Provider Demographics
NPI:1669186706
Name:HEYN, SHELBY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:HEYN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7273 CLEARWATER RD APT 302
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-5908
Mailing Address - Country:US
Mailing Address - Phone:218-820-0189
Mailing Address - Fax:
Practice Address - Street 1:804 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4441
Practice Address - Country:US
Practice Address - Phone:218-829-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN518141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist