Provider Demographics
NPI:1902181050
Name:WILLIAMS, SHELLEY (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SHELLEY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46225
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-0225
Mailing Address - Country:US
Mailing Address - Phone:206-709-4393
Mailing Address - Fax:
Practice Address - Street 1:9032 25TH AVE SW
Practice Address - Street 2:#301J
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-3246
Practice Address - Country:US
Practice Address - Phone:206-709-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00002793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist