Provider Demographics
NPI:1194188904
Name:WILLIAMS, CARLA JENICE (AUD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:JENICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S PADRE ISLAND DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-4121
Mailing Address - Country:US
Mailing Address - Phone:361-288-7831
Mailing Address - Fax:
Practice Address - Street 1:412 S HENDERSON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1017
Practice Address - Country:US
Practice Address - Phone:817-719-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA4067231H00000X
FLAY2245231H00000X
TX81809231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist