Olivia Marie Willishenry, MA CCC SLP, MA CCC-A

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SP5477 Issued in CA

Practice address

555 Saturn Blvd
Suite 361
San Diego, CA 92154-4766

Phone

(951) 473-9570

NPI assigned

Sep 21, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703376000000",
    "number": "1609100874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 SATURN BLVD # B361",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921544766",
            "telephone_number": "818-488-4349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 SATURN BLVD",
            "address_2": "SUITE 361",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921544766",
            "telephone_number": "951-473-9570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLISHENRY",
        "first_name": "OLIVIA",
        "middle_name": "MARIE",
        "credential": "MA CCC SLP, MA CCC-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-21",
        "last_updated": "2023-12-24",
        "certification_date": "2023-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CA",
            "license": "AU874",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP5477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH PATHOLOGY LICENSE NUMBER",
            "identifier": "SP5477",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Willis, MA
• Judith Willis
• Mary Jane Hall Willis, M.D.
• Molly Willis
• Robert Willis
• Dana Willison
• Anna Kristell Willmer, NP
• Kimberly Willmott
• David C Willms, M.D.
• Maria Willms

• Speech-Language Pathologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.