Provider Demographics
NPI:1699882209
Name:WILLIAMS, JOELLEN (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JOELLEN
Middle Name:
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 1:121 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1615
Mailing Address - Country:US
Mailing Address - Phone:318-614-7400
Mailing Address - Fax:318-396-2204
Practice Address - Street 1:121 JORDAN RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-1615
Practice Address - Country:US
Practice Address - Phone:318-614-7400
Practice Address - Fax:318-396-2204
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA196637Medicare ID - Type UnspecifiedMEDICARE GROUP PRACTICE