Provider Demographics
NPI:1003407529
Name:WILLIAMS, MIKEL M (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:MIKEL
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1556 MAGUIRE RD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2982
Mailing Address - Country:US
Mailing Address - Phone:407-877-2272
Mailing Address - Fax:
Practice Address - Street 1:1556 MAGUIRE RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2982
Practice Address - Country:US
Practice Address - Phone:407-877-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist