Provider Demographics
NPI:1558633529
Name:WILLIAMS, MELINDA MARIE (SLPA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MARIE
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 N DYSART RD
Mailing Address - Street 2:B112
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3045
Mailing Address - Country:US
Mailing Address - Phone:623-935-6040
Mailing Address - Fax:
Practice Address - Street 1:5220 N DYSART RD
Practice Address - Street 2:B112
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-3045
Practice Address - Country:US
Practice Address - Phone:623-935-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA7620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist