Provider Demographics
NPI:1396082905
Name:WILLIAMS, PATRICIA
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 WALTERS RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-3722
Mailing Address - Country:US
Mailing Address - Phone:845-242-1651
Mailing Address - Fax:
Practice Address - Street 1:1717 WEYBURN RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-1722
Practice Address - Country:US
Practice Address - Phone:410-887-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009486235Z00000X
MD08160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL009486OtherBUREAU OF PROFESSIONAL OCCUPATIONAL AFFAIRS