Provider Demographics
NPI:1972125771
Name:WILLIAMS, ADELE R (MS/CCC/SLP)
Entity type:Individual
Prefix:
First Name:ADELE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8506 LONG BOW LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3176
Mailing Address - Country:US
Mailing Address - Phone:951-640-0358
Mailing Address - Fax:
Practice Address - Street 1:8506 LONG BOW LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3176
Practice Address - Country:US
Practice Address - Phone:951-640-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242665235Z00000X
CA29038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist