Provider Demographics
NPI:1619061272
Name:WILLIAMS, HEIDI JEAN (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 AFTON DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VAMC 117A
Practice Address - Street 2:4100 WEST THIRD AVE.
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428
Practice Address - Country:US
Practice Address - Phone:937-262-2148
Practice Address - Fax:937-267-5322
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist