Provider Demographics
NPI:1972915999
Name:WILLIAMS, JESSICA LYNN (MS, SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 E THOMAS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7761
Mailing Address - Country:US
Mailing Address - Phone:602-933-3124
Mailing Address - Fax:
Practice Address - Street 1:124 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4414
Practice Address - Country:US
Practice Address - Phone:602-933-0500
Practice Address - Fax:602-933-4320
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP8856235Z00000X
AZSLP13342235Z00000X
AZSLP8856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist