Provider Demographics
NPI:1750569331
Name:WILLIAMS, KELLE PATRICE (MS)
Entity type:Individual
Prefix:
First Name:KELLE
Middle Name:PATRICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 RIVER PARK DR
Mailing Address - Street 2:SUITE 206L
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4612
Mailing Address - Country:US
Mailing Address - Phone:916-921-6023
Mailing Address - Fax:916-921-1492
Practice Address - Street 1:1555 RIVER PARK DR
Practice Address - Street 2:SUITE 206L
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4612
Practice Address - Country:US
Practice Address - Phone:916-921-6023
Practice Address - Fax:916-921-1492
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2175231H00000X
CO473231H00000X
CAHA5001237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter