Healthcare Provider Details

I. General information

NPI: 1689753972
Provider Name (Legal Business Name): PAMELA SUE WILLIAMS BS AA AS IECE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 ANDY'S XING
CHAVIES KY
41727
US

IV. Provider business mailing address

98 ANDY'S XING
CHAVIES KY
41727
US

V. Phone/Fax

Practice location:
  • Phone: 606-435-0064
  • Fax: 606-435-0064
Mailing address:
  • Phone: 606-435-0064
  • Fax: 606-435-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: