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General NPI Number Information
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NPI Number | 1114455003
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Entity Type | Individual
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Provider Name | KELLY JEAN WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 05/23/2017
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Last Update Date | 05/23/2017
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Provider Practice Location Address
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Address Line | 2781 JEFFERSON DAVIS HWY STE 103
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City | STAFFORD
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State | VA
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Zip | 22554-8322
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Country | US
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Telephone | 540-659-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 621 COBBLESTONE BLVD UNIT 310
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-6611
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | VA
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