Healthcare Provider Details

I. General information

NPI: 1871712265
Provider Name (Legal Business Name): CHRISTINA WILLIAMS MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 N CENTENNIAL AVE
WEST FORK AR
72774-2711
US

IV. Provider business mailing address

984 PEMBRIDGE DR
CAVE SPRINGS AR
72718-9421
US

V. Phone/Fax

Practice location:
  • Phone: 479-871-9820
  • Fax: 479-203-7400
Mailing address:
  • Phone: 479-871-9820
  • Fax: 479-203-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberAR1988
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: