=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922954775
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONYA ELENA CHIBA KELLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2026
-----------------------------------------------------
Last Update Date | 03/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9020 BLAINE ST
-----------------------------------------------------
City | JOINT BASE LEWIS MCCHORD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98433-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-583-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3015 E MAIN APT C8
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-3192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | SLPA.SP.70097781
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------