Provider Demographics
NPI:1922519750
Name:WILLIAMSON, SHANA FRICKS (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:FRICKS
Last Name:WILLIAMSON
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 1:14585 COLONEL GLENN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-2222
Mailing Address - Country:US
Mailing Address - Phone:501-231-4411
Mailing Address - Fax:
Practice Address - Street 1:5820 ASHER AVE STE 600
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7871
Practice Address - Country:US
Practice Address - Phone:501-569-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist