Provider Demographics
NPI:1841748753
Name:WASHINGTON, DARLENE MARIA
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:MARIA
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:MARIA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 S HOLLYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4801
Mailing Address - Country:US
Mailing Address - Phone:901-416-5300
Mailing Address - Fax:
Practice Address - Street 1:160 S HOLLYWOOD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4801
Practice Address - Country:US
Practice Address - Phone:901-416-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist