Provider Demographics
NPI:1285362640
Name:WILLIAMS, MARCIE GWEN (MS, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:MARCIE
Middle Name:GWEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-4918
Mailing Address - Country:US
Mailing Address - Phone:806-677-2380
Mailing Address - Fax:
Practice Address - Street 1:5108 PICO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79110-4918
Practice Address - Country:US
Practice Address - Phone:806-677-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist