Provider Demographics
NPI:1689419012
Name:PEEK, SHELLE DIANE (SLP, CCC)
Entity type:Individual
Prefix:
First Name:SHELLE
Middle Name:DIANE
Last Name:PEEK
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6732 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1169
Mailing Address - Country:US
Mailing Address - Phone:785-553-9975
Mailing Address - Fax:
Practice Address - Street 1:1338 N SCHOOL ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KS
Practice Address - Zip Code:66402-9489
Practice Address - Country:US
Practice Address - Phone:785-249-2156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4370235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist