Provider Demographics
NPI:1508312901
Name:WALTERS, ALLYSHA
Entity Type:Individual
Prefix:MISS
First Name:ALLYSHA
Middle Name:
Last Name:WALTERS
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 1:8074 KENSINGTON BLVD
Mailing Address - Street 2:229
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2241
Mailing Address - Country:US
Mailing Address - Phone:989-493-2904
Mailing Address - Fax:
Practice Address - Street 1:3508 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-8768
Practice Address - Country:US
Practice Address - Phone:810-212-1134
Practice Address - Fax:810-212-1135
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14089774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist