Provider Demographics
NPI:1578730396
Name:WILLIAMS, LAKISHA (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5740
Mailing Address - Country:US
Mailing Address - Phone:937-233-1230
Mailing Address - Fax:
Practice Address - Street 1:4710 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-5740
Practice Address - Country:US
Practice Address - Phone:937-233-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2017-04-19
Deactivation Date:2014-11-18
Deactivation Code:
Reactivation Date:2017-04-19
Provider Licenses
StateLicense IDTaxonomies
OHA01570231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist