Provider Demographics
NPI:1437223096
Name:WILLIAMS, MARGARET MAR (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MAR
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:PO BOX 55
Mailing Address - Street 2:4604 WEST RIPPLE DRIVE
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084
Mailing Address - Country:US
Mailing Address - Phone:801-282-0954
Mailing Address - Fax:801-955-2540
Practice Address - Street 1:6246 S REDWOOD ROAD
Practice Address - Street 2:AVALON BENNION CARE CENTER
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123
Practice Address - Country:US
Practice Address - Phone:801-969-1420
Practice Address - Fax:801-955-2540
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4950184-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD4215Medicaid