Provider Demographics
NPI:1508200650
Name:WILLIAMS, KELLY MC CARTHY (SLPA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MC CARTHY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 W 104TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-6102
Mailing Address - Country:US
Mailing Address - Phone:888-711-6272
Mailing Address - Fax:
Practice Address - Street 1:5220 W 104TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6102
Practice Address - Country:US
Practice Address - Phone:888-711-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23522355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant