Provider Demographics
NPI:1134187628
Name:WILLIAMSON, REEDA RUTH (MSE, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REEDA
Middle Name:RUTH
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MSE, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20900 ROLAND HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72135-9685
Mailing Address - Country:US
Mailing Address - Phone:501-868-4760
Mailing Address - Fax:501-868-6498
Practice Address - Street 1:20900 ROLAND HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:AR
Practice Address - Zip Code:72135-9685
Practice Address - Country:US
Practice Address - Phone:501-868-4760
Practice Address - Fax:501-868-6498
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP #1076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X350OtherSLP WITH BCBS