Provider Demographics
NPI:1932254497
Name:HAYES-WILLIAMS, BRENDA R (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:R
Last Name:HAYES-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 1:1001 N LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8713
Mailing Address - Country:US
Mailing Address - Phone:601-750-4796
Mailing Address - Fax:
Practice Address - Street 1:1001 N LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8713
Practice Address - Country:US
Practice Address - Phone:601-750-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS1183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120399Medicaid