Healthcare Provider Details

I. General information

NPI: 1710226725
Provider Name (Legal Business Name): KRISHYRA DENYELL WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 BALBOA BLVD STE 242
NORTHRIDGE CA
91325-3593
US

IV. Provider business mailing address

2608 TANOAK TER
WINTER HAVEN FL
33881-3831
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 910-578-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5409
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12438
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1303187
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: