Provider Demographics
NPI:1407820012
Name:WILLIAMS, BRANDY JERNIGAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:JERNIGAN
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 1:105 GREENWAY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-9478
Mailing Address - Country:US
Mailing Address - Phone:704-907-4610
Mailing Address - Fax:704-820-8025
Practice Address - Street 1:105 GREENWAY VIEW CT
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-9478
Practice Address - Country:US
Practice Address - Phone:704-907-4610
Practice Address - Fax:704-820-8025
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412342Medicaid