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General NPI Number Information
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NPI Number | 1922519750
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Entity Type | Individual
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Provider Name | SHANA FRICKS WILLIAMSON M.S.,CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 5820 ASHER AVE STE 600
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City | LITTLE ROCK
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State | AR
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Zip | 72204-7871
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Country | US
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Telephone | 501-569-3155
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Fax |
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Provider Business Mailing Address
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Address Line | 14585 COLONEL GLENN RD
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City | LITTLE ROCK
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State | AR
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Zip | 72210-2222
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Country | US
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Telephone | 501-231-4411
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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 | 1486
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License Number State | AR
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