Provider Demographics
NPI:1205182409
Name:WILLIAMS, DEBRA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16480 VALHALLA DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-7174
Mailing Address - Country:US
Mailing Address - Phone:317-773-2164
Mailing Address - Fax:
Practice Address - Street 1:16480 VALHALLA DR
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-7174
Practice Address - Country:US
Practice Address - Phone:317-773-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005450A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist