Provider Demographics
NPI:1114254109
Name:WILLIAMS-SMITH, KACI B (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:B
Last Name:WILLIAMS-SMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:B
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3519
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39303-3519
Mailing Address - Country:US
Mailing Address - Phone:601-581-1191
Mailing Address - Fax:888-501-7784
Practice Address - Street 1:1502 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-1552
Practice Address - Country:US
Practice Address - Phone:334-341-4548
Practice Address - Fax:334-341-5168
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist