Provider Demographics
NPI:1154562486
Name:WILLIAMS, MARGARETTE ANNE (EDD, CCC)
Entity type:Individual
Prefix:DR
First Name:MARGARETTE
Middle Name:ANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:EDD, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-4032
Mailing Address - Country:US
Mailing Address - Phone:870-535-5665
Mailing Address - Fax:870-535-5554
Practice Address - Street 1:901 WEST 6TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-4032
Practice Address - Country:US
Practice Address - Phone:870-535-5665
Practice Address - Fax:870-535-5554
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSLP558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119167721Medicaid
AR235Z00000XMedicaid