Provider Demographics
NPI:1033699111
Name:WILLIAMS, SANDRA KAY (RN, BSN, HIS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, BSN, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4012
Mailing Address - Country:US
Mailing Address - Phone:217-246-1118
Mailing Address - Fax:
Practice Address - Street 1:1300 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4012
Practice Address - Country:US
Practice Address - Phone:217-246-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3283237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist