MEDICARE: ADRIENNE NICHOLLE WILLIAMS MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist	SP1227	NV

General Provider Information

NPI Number	:	1538478912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE NICHOLLE WILLIAMS MS, CCC-SLP

Provider Business Mailing Address
First Line	:	3101 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1931
Country	:	US
Telephone Number	:	702-831-6670
Fax Number	:	702-831-6671

Provider Business Practice Location Address
First Line	:	3009 W CHARLESTON BLVD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1943
Country	:	US
Telephone Number	:	702-831-6670
Fax Number	:	702-831-6671

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2010
Last Update Date	:	08/15/2023

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