Provider Demographics
NPI:1457515561
Name:WILLIAMS, LISA-MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA-MARIE
Middle Name:
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 1:11120 NW 1ST CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8140
Mailing Address - Country:US
Mailing Address - Phone:954-873-2429
Mailing Address - Fax:
Practice Address - Street 1:11120 NW 1ST CT
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8140
Practice Address - Country:US
Practice Address - Phone:954-873-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist