Provider Demographics
NPI:1902465800
Name:WILLIAMS, KIRSTEN
Entity type:Individual
Prefix:
First Name:KIRSTEN
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 1:802 E MARTINTOWN RD STE 403
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-5328
Mailing Address - Country:US
Mailing Address - Phone:803-216-1522
Mailing Address - Fax:833-799-3525
Practice Address - Street 1:802 E MARTINTOWN RD STE 403
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-5328
Practice Address - Country:US
Practice Address - Phone:803-216-1522
Practice Address - Fax:833-799-3525
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011042235Z00000X
SC8237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist