Provider Demographics
NPI:1669876595
Name:WILLIAMS, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 HAWTHORN DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3184
Mailing Address - Country:US
Mailing Address - Phone:214-600-3785
Mailing Address - Fax:972-637-3635
Practice Address - Street 1:708 HAWTHORN DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3184
Practice Address - Country:US
Practice Address - Phone:214-600-3785
Practice Address - Fax:972-637-3635
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care