Provider Demographics
NPI:1447567144
Name:WILLIAMS, MARCIA (SLP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 CALL CREEK DR STE 4B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3072
Mailing Address - Country:US
Mailing Address - Phone:208-233-4600
Mailing Address - Fax:208-233-4262
Practice Address - Street 1:1110 CALL CREEK DR STE 4B
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3072
Practice Address - Country:US
Practice Address - Phone:208-233-4600
Practice Address - Fax:208-233-4262
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP1311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist