Provider Demographics
NPI:1104020239
Name:MCWILLIAMS, MAURA (SLP)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 MARNA LYNN AVE NW
Mailing Address - Street 2:PETROGLYPH ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5701
Mailing Address - Country:US
Mailing Address - Phone:505-898-0923
Mailing Address - Fax:
Practice Address - Street 1:5100 MARNA LYNN AVE NW
Practice Address - Street 2:PETROGLYPH ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5701
Practice Address - Country:US
Practice Address - Phone:505-898-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH 2301Medicaid