Provider Demographics
NPI:1568516367
Name:WILLIAMS, MISTY LEANN (MS, CCC)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LEANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7433 GREENVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7140
Mailing Address - Country:US
Mailing Address - Phone:561-641-6177
Mailing Address - Fax:561-641-1481
Practice Address - Street 1:7433 GREENVILLE CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7140
Practice Address - Country:US
Practice Address - Phone:561-641-6177
Practice Address - Fax:561-641-1481
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 2460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8840075Medicaid