Provider Demographics
NPI:1790862472
Name:WILLIAMS, KIM ANN (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 E VINA DEL MAR BLVD
Mailing Address - Street 2:
Mailing Address - City:ST PETE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33706-2828
Mailing Address - Country:US
Mailing Address - Phone:941-371-8820
Mailing Address - Fax:941-378-0611
Practice Address - Street 1:4620 17TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-1843
Practice Address - Country:US
Practice Address - Phone:941-371-8820
Practice Address - Fax:941-378-0611
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811531100Medicaid
FL882470300Medicaid
FLSA3098OtherLICENSE SPEECH-LANGUAGE