Provider Demographics
NPI:1124763701
Name:WILLIAMS, MARJORIE BETH
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:BETH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:M.
Other - Middle Name:BETH
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:2151 KINCAID PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1900
Mailing Address - Country:US
Mailing Address - Phone:281-935-5993
Mailing Address - Fax:
Practice Address - Street 1:1500 E 128TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2601
Practice Address - Country:US
Practice Address - Phone:720-972-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24458448235Z00000X
TX100915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist