Provider Demographics
NPI:1346490067
Name:WILLIAMS, KOMAL S (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KOMAL
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 W RITTENHOUSE ST
Mailing Address - Street 2:APT A619
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3834
Mailing Address - Country:US
Mailing Address - Phone:419-348-9162
Mailing Address - Fax:
Practice Address - Street 1:638 BRANDYWINE PKWY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4278
Practice Address - Country:US
Practice Address - Phone:610-436-3600
Practice Address - Fax:610-436-3606
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
PASL012071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174400000XOther Service ProvidersSpecialist