Allysha Walters

Key facts

NPI

1508312901

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

14089774 (MI)

Practice address

3508 S Lapeer Rd
Metamora, MI 48455-8768

Phone

(810) 212-1134

Fax

(810) 212-1135

NPI assigned

Aug 26, 2016

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 26, 2016.

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472169600000",
    "number": "1508312901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8074 KENSINGTON BLVD",
            "address_2": "229",
            "city": "DAVISON",
            "state": "MI",
            "postal_code": "484232241",
            "telephone_number": "989-493-2904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3508 S LAPEER RD",
            "city": "METAMORA",
            "state": "MI",
            "postal_code": "484558768",
            "telephone_number": "810-212-1134",
            "fax_number": "810-212-1135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "ALLYSHA",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-26",
        "last_updated": "2016-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "14089774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Metamora, MI · Speech-Language Pathologist in Michigan