Provider Demographics
NPI:1629811849
Name:WILLIAMS, JAIDEN (CFY-SLP)
Entity type:Individual
Prefix:MS
First Name:JAIDEN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 SUNNYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-2636
Mailing Address - Country:US
Mailing Address - Phone:757-819-3063
Mailing Address - Fax:
Practice Address - Street 1:1062 W MERCURY BLVD STE 1062B
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1068
Practice Address - Country:US
Practice Address - Phone:757-644-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist