Provider Demographics
NPI:1588836514
Name:WILLILAMS-REED, SHERICA ANSHON (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERICA
Middle Name:ANSHON
Last Name:WILLILAMS-REED
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:SHERICA
Other - Middle Name:ANSHON
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:156 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DREW
Mailing Address - State:MS
Mailing Address - Zip Code:38737-3304
Mailing Address - Country:US
Mailing Address - Phone:662-398-9559
Mailing Address - Fax:
Practice Address - Street 1:405 EAST THIRD AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MS
Practice Address - Zip Code:38774
Practice Address - Country:US
Practice Address - Phone:662-398-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03281809Medicaid