Provider Demographics
NPI:1508890898
Name:WILLIAMS, SHALONDA NICOLE (SLP)
Entity Type:Individual
Prefix:MS
First Name:SHALONDA
Middle Name:NICOLE
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 1:2001 TEXAN DR
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-8791
Mailing Address - Country:US
Mailing Address - Phone:817-698-1700
Mailing Address - Fax:
Practice Address - Street 1:2001 TEXAN DR
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-8791
Practice Address - Country:US
Practice Address - Phone:817-698-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1530743-01Medicaid