Provider Demographics
NPI:1114395308
Name:WILLIAMS, KELLY ANNE
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 PROGRESS DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-2929
Mailing Address - Country:US
Mailing Address - Phone:407-882-0468
Mailing Address - Fax:
Practice Address - Street 1:3280 PROGRESS DR
Practice Address - Street 2:SUITE 500
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-2929
Practice Address - Country:US
Practice Address - Phone:407-882-0468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist