Provider Demographics
NPI:1518181551
Name:WILLIAMSON, MARY REBECCA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:REBECCA
Last Name:WILLIAMSON
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 1:502 E UNION
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3669
Mailing Address - Country:US
Mailing Address - Phone:870-904-6063
Mailing Address - Fax:
Practice Address - Street 1:301 W CALHOUN
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3508
Practice Address - Country:US
Practice Address - Phone:870-234-1597
Practice Address - Fax:870-234-1797
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152679721Medicaid