Provider Demographics
NPI:1467509588
Name:WILLIAMS, CHARRON MICHELLE (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CHARRON
Middle Name:MICHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19600 ROSLYN RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1842
Mailing Address - Country:US
Mailing Address - Phone:703-200-6494
Mailing Address - Fax:
Practice Address - Street 1:19600 ROSLYN RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1842
Practice Address - Country:US
Practice Address - Phone:703-200-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist