Provider Demographics
NPI:1669887758
Name:WILLIAMS, HALEY
Entity type:Individual
Prefix:
First Name:HALEY
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 1:105 NORTH RIEBELING STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2045
Mailing Address - Country:US
Mailing Address - Phone:618-615-1784
Mailing Address - Fax:815-725-9993
Practice Address - Street 1:105 NORTH RIEBELING STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2045
Practice Address - Country:US
Practice Address - Phone:618-615-1784
Practice Address - Fax:815-725-9993
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist