Provider Demographics
NPI:1598814410
Name:WILLIAMS, MARYMAC (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARYMAC
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2036
Mailing Address - Country:US
Mailing Address - Phone:803-738-0426
Mailing Address - Fax:
Practice Address - Street 1:820 KIPLING DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2036
Practice Address - Country:US
Practice Address - Phone:803-738-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist