Provider Demographics
NPI:1790198950
Name:WILLIAMS, MATTHEW R (HIS)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 WEST HUNTER ST.
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138
Mailing Address - Country:US
Mailing Address - Phone:740-385-9966
Mailing Address - Fax:740-385-9966
Practice Address - Street 1:1323 WEST HUNTER ST.
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138
Practice Address - Country:US
Practice Address - Phone:740-385-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00238231H00000X
OH03072237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist