Provider Demographics
NPI:1780714014
Name:WILLIAMSON, PHOEBE ROSIMO (MED,MS)
Entity type:Individual
Prefix:MRS
First Name:PHOEBE
Middle Name:ROSIMO
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MED,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18735
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40261-0735
Mailing Address - Country:US
Mailing Address - Phone:502-553-0360
Mailing Address - Fax:502-459-6344
Practice Address - Street 1:4910 SIMPSON DRIVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-553-0360
Practice Address - Fax:502-459-6344
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
KY1921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1375OtherPRIMARY EVALUATOR
KY1375OtherSPEECH