MEDICARE: MISS SHELLEY WILLIAMS MA CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	LL 00002793	WA

General Provider Information

NPI Number	:	1902181050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHELLEY WILLIAMS MA CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 46225
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-0225
Country	:	US
Telephone Number	:	206-709-4393
Fax Number	:

Provider Business Practice Location Address
First Line	:	9032 25TH AVE SW
Second Line	:	#301J
City	:	SEATTLE
State	:	WA
Zip	:	98106-3246
Country	:	US
Telephone Number	:	206-709-4393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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