Provider Demographics
NPI:1710299409
Name:WILLIAMS, HEATHER SARA (MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:SARA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3923
Mailing Address - Country:US
Mailing Address - Phone:516-599-4220
Mailing Address - Fax:
Practice Address - Street 1:14 S FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3923
Practice Address - Country:US
Practice Address - Phone:516-599-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11728-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist