Provider Demographics
NPI:1619379104
Name:WILLIAMS, KARIN
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:1115 N. CALIFORNIA ST
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-0000
Mailing Address - Country:US
Mailing Address - Phone:575-838-0800
Mailing Address - Fax:575-838-3999
Practice Address - Street 1:1115 N. CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-0000
Practice Address - Country:US
Practice Address - Phone:575-838-0800
Practice Address - Fax:575-838-3999
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist