Provider Demographics
NPI:1093054124
Name:WILLIAMSON, RENEE J (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:J
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 OLD WHARF RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-8943
Mailing Address - Country:US
Mailing Address - Phone:912-269-9926
Mailing Address - Fax:
Practice Address - Street 1:117 OLD WHARF RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-8943
Practice Address - Country:US
Practice Address - Phone:912-269-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist