Provider Demographics
NPI:1427320696
Name:WILLIAMS, KRISTIN WESLEY (MS)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:WESLEY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:WESLEY
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7237
Mailing Address - Country:US
Mailing Address - Phone:714-658-4193
Mailing Address - Fax:
Practice Address - Street 1:6 WILLOW WAY
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-7237
Practice Address - Country:US
Practice Address - Phone:714-658-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist