Provider Demographics
NPI:1407227705
Name:WILLIAMS, CHARNELLE
Entity Type:Individual
Prefix:
First Name:CHARNELLE
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 1:510 S. EXTENSION ROAD
Mailing Address - Street 2:APT 2023
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:928-660-3157
Mailing Address - Fax:
Practice Address - Street 1:510 S EXTENSION RD
Practice Address - Street 2:APT 2023
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2249
Practice Address - Country:US
Practice Address - Phone:928-660-3157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA96062355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant