Provider Demographics
NPI:1780158741
Name:WILLIAMS, DEONDRA KRESHAY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEONDRA
Middle Name:KRESHAY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 CUTTEN RD APT 1217
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3371
Mailing Address - Country:US
Mailing Address - Phone:601-616-2730
Mailing Address - Fax:
Practice Address - Street 1:17200 STATE HIGHWAY 249 STE 170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1319
Practice Address - Country:US
Practice Address - Phone:281-379-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist