Provider Demographics
NPI:1740912856
Name:WILLIAMS, JENNIFER (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9544
Mailing Address - Country:US
Mailing Address - Phone:860-987-7374
Mailing Address - Fax:
Practice Address - Street 1:124 KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9544
Practice Address - Country:US
Practice Address - Phone:860-987-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT8901022626OtherEDUCATOR CERTIFICATION
CT004640OtherPUBLIC HEALTH
14072103OtherASHA