Provider Demographics
NPI:1285043737
Name:WILLIAMS, JENNIFER
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
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:ANTONIA MIDDLE SCHOOL
Mailing Address - Street 2:6798 ST. LUKES CHURCH RD.
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012
Mailing Address - Country:US
Mailing Address - Phone:636-282-6970
Mailing Address - Fax:
Practice Address - Street 1:3901 OLD STATE ROAD M
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-2954
Practice Address - Country:US
Practice Address - Phone:636-942-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist