Provider Demographics
NPI:1780801134
Name:WILLIAMS, PATRICIA K (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8657 HILLSIDE TRL S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3258
Mailing Address - Country:US
Mailing Address - Phone:651-459-0772
Mailing Address - Fax:
Practice Address - Street 1:324 JOHNSON PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6412
Practice Address - Country:US
Practice Address - Phone:651-793-3225
Practice Address - Fax:651-793-3213
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist