Healthcare Provider Details

I. General information

NPI: 1891627048
Provider Name (Legal Business Name): REBECCA WILLIAMS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

110 CLONTZ RD
MONROE NC
28110-9794
US

IV. Provider business mailing address

110 CLONTZ RD
MONROE NC
28110-9794
US

V. Phone/Fax

Practice location:
  • Phone: 704-296-6332
  • Fax:
Mailing address:
  • Phone: 704-296-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12081943
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: