Provider Demographics
NPI:1942544069
Name:LATHAM, SHELBY NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:NICOLE
Last Name:LATHAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1539
Mailing Address - Country:US
Mailing Address - Phone:270-641-0165
Mailing Address - Fax:270-713-1718
Practice Address - Street 1:123 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1539
Practice Address - Country:US
Practice Address - Phone:270-977-6707
Practice Address - Fax:270-713-1718
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY142307235Z00000X
4123235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist