Provider Demographics
NPI:1790352003
Name:SEWELL, MARISSA WILLIAMSON (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:WILLIAMSON
Last Name:SEWELL
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:DIANE
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC-SLP
Mailing Address - Street 1:3803 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-3025
Mailing Address - Country:US
Mailing Address - Phone:256-459-5051
Mailing Address - Fax:
Practice Address - Street 1:3803 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-3025
Practice Address - Country:US
Practice Address - Phone:256-459-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-06
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty