Provider Demographics
NPI:1285978254
Name:WILLIAMS, JAMES T
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CHANNING WAY STE A101
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7561
Mailing Address - Country:US
Mailing Address - Phone:208-552-1166
Mailing Address - Fax:208-552-0470
Practice Address - Street 1:3200 CHANNING WAY STE A101
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7561
Practice Address - Country:US
Practice Address - Phone:208-552-1166
Practice Address - Fax:208-552-0470
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHA-1852237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist