Provider Demographics
NPI:1578176202
Name:WILLIAMS, KAYLAN
Entity Type:Individual
Prefix:
First Name:KAYLAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 WESTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38620-9458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:643 WESTBROOK RD
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:MS
Practice Address - Zip Code:38620-9458
Practice Address - Country:US
Practice Address - Phone:662-609-1376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist