Provider Demographics
NPI:1235282963
Name:WILLIAMS TE, LESLIE A (AUD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:WILLIAMS TE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2801 S BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6137
Mailing Address - Country:US
Mailing Address - Phone:405-340-9191
Mailing Address - Fax:405-340-9185
Practice Address - Street 1:2801 S BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6137
Practice Address - Country:US
Practice Address - Phone:405-340-9191
Practice Address - Fax:405-340-9185
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA#289231H00000X
OK377231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200103300AMedicaid