Provider Demographics
NPI:1154771517
Name:WILLIAMS, JORDAN LINDSEY
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:LINDSEY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LINDSEY
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1167 LILY FIELD LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3203
Mailing Address - Country:US
Mailing Address - Phone:618-292-9541
Mailing Address - Fax:
Practice Address - Street 1:3007 WOODLAND HILLS DR # 94
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1403
Practice Address - Country:US
Practice Address - Phone:832-412-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory