Provider Demographics
NPI:1497029649
Name:B WILLIAMS EVALUATIVE
Entity Type:Organization
Organization Name:B WILLIAMS EVALUATIVE
Other - Org Name:BRENDA HAYES-WILLIAMS & ASSOCIATES THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAYES-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:601-750-4796
Mailing Address - Street 1:1001 N LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8713
Mailing Address - Country:US
Mailing Address - Phone:601-750-4796
Mailing Address - Fax:601-605-4567
Practice Address - Street 1:1001 N LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8713
Practice Address - Country:US
Practice Address - Phone:601-750-4796
Practice Address - Fax:601-605-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120399Medicaid