Provider Demographics
NPI:1093022931
Name:WILLIAMS, JESSICA L (HIS)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GLENDON ST
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4481
Mailing Address - Country:US
Mailing Address - Phone:603-569-2799
Mailing Address - Fax:603-569-1815
Practice Address - Street 1:22 GLENDON ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4481
Practice Address - Country:US
Practice Address - Phone:603-569-2799
Practice Address - Fax:603-569-1815
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHH501237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist