Provider Demographics
NPI:1184063893
Name:WILLEY, MONICA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:WILLEY
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 1:405 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-4941
Mailing Address - Country:US
Mailing Address - Phone:740-891-8637
Mailing Address - Fax:
Practice Address - Street 1:405 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4941
Practice Address - Country:US
Practice Address - Phone:740-891-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist