MEDICARE: MRS. MARYMAC WILLIAMS M.A. 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	3360	SC

General Provider Information

NPI Number	:	1598814410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYMAC WILLIAMS M.A. CCC SLP

Provider Business Mailing Address
First Line	:	820 KIPLING DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-2036
Country	:	US
Telephone Number	:	803-738-0426
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 KIPLING DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-2036
Country	:	US
Telephone Number	:	803-738-0426
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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