Provider Demographics
NPI:1851637656
Name:WILLIAMSON, GINA KAYE (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:KAYE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HARDWAY RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-8304
Mailing Address - Country:US
Mailing Address - Phone:501-253-8444
Mailing Address - Fax:
Practice Address - Street 1:440 HARDWAY RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-8304
Practice Address - Country:US
Practice Address - Phone:501-253-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-25
Last Update Date:2012-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist