MEDICARE: JORI MARIE WILLIAMS M.H.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	16717	CA

General Provider Information

NPI Number	:	1538429717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORI MARIE WILLIAMS M.H.S. CCC-SLP

Provider Business Mailing Address
First Line	:	134 S BROADWAY
Second Line	:	UNIT C
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3304
Country	:	US
Telephone Number	:	708-288-0783
Fax Number	:

Provider Business Practice Location Address
First Line	:	3521 LOMITA BLVD
Second Line	:	SUITE 201
City	:	TORRANCE
State	:	CA
Zip	:	90505-5039
Country	:	US
Telephone Number	:	310-856-8528
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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