Provider Demographics
NPI:1083860050
Name:WILLIAMS, WANDA F, (MAEDCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:F,
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MAEDCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5551 RAPPAHANNOCK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-6637
Mailing Address - Country:US
Mailing Address - Phone:901-382-2720
Mailing Address - Fax:
Practice Address - Street 1:6025 PRIMACY PARKWAY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5763
Practice Address - Country:US
Practice Address - Phone:901-818-5932
Practice Address - Fax:901-374-9603
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000001033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist