Provider Demographics
NPI:1538682158
Name:WILLIAMSON, PAUL (SLP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2135
Mailing Address - Country:US
Mailing Address - Phone:253-686-9112
Mailing Address - Fax:
Practice Address - Street 1:5412 29TH ST NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-3204
Practice Address - Country:US
Practice Address - Phone:253-571-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60642509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA14264209OtherASHA