Provider Demographics
NPI:1396204822
Name:WILLIAMS, JADEN (SCAT, LAT)
Entity Type:Individual
Prefix:
First Name:JADEN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:SCAT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 KING OF ARMS CT APT A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4334
Mailing Address - Country:US
Mailing Address - Phone:571-969-9992
Mailing Address - Fax:
Practice Address - Street 1:2100 S FLOYD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2805
Practice Address - Country:US
Practice Address - Phone:502-852-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer