MEDICARE: MRS. CHARLENE T WILLIAMSON MA, 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	235Z00000X	Speech-Language Pathologist	3584	LA

General Provider Information

NPI Number	:	1861652380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLENE T WILLIAMSON MA, CCC, SLP

Provider Business Mailing Address
First Line	:	1115 ETTA DR
Second Line	:
City	:	SAINT GABRIEL
State	:	LA
Zip	:	70776-5619
Country	:	US
Telephone Number	:	225-939-7205
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 S BURNSIDE AVE STE 2
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-3400
Country	:	US
Telephone Number	:	225-437-9535
Fax Number	:	225-647-3704

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/06/2023

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Directions to “ MRS. CHARLENE T WILLIAMSON MA, CCC, SLP” Practice Location

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