Provider Demographics
NPI:1790016780
Name:WILLIAMS, BETSY M (MED,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PASO ST
Mailing Address - Street 2:P.O. BOX 340
Mailing Address - City:RURAL HALL
Mailing Address - State:NC
Mailing Address - Zip Code:27045-9318
Mailing Address - Country:US
Mailing Address - Phone:336-969-2755
Mailing Address - Fax:
Practice Address - Street 1:2601 REYNOLDA RD
Practice Address - Street 2:BRIGHTON GARDENS OF WINSTON-SALEM
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106
Practice Address - Country:US
Practice Address - Phone:336-722-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC87667OtherBCBSNC
NC7487667Medicaid