Provider Demographics
NPI:1578942983
Name:WILLIAMS, DEBRA (MS CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:WILLIAMS
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 1:3710 CATTAIL DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-3260
Mailing Address - Country:US
Mailing Address - Phone:904-612-1072
Mailing Address - Fax:
Practice Address - Street 1:3710 CATTAIL DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-3260
Practice Address - Country:US
Practice Address - Phone:904-612-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist