Provider Demographics
NPI:1205975612
Name:NELSON, CAROL KAY (MS CCC)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:KAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:KAY
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC
Mailing Address - Street 1:8410 45TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-564-5506
Mailing Address - Fax:
Practice Address - Street 1:33515 10 PL S
Practice Address - Street 2:13 CC MANNING AND ASSOCIATES
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7300
Practice Address - Country:US
Practice Address - Phone:253-874-2599
Practice Address - Fax:253-874-2392
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8338469Medicaid