Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor |
NPI | 1003361015 |
---|---|
Provider Name | Katelyn Ann Williams |
First Address | Providence, RI 02904-2729 |
Second Address | Providence, RI 02906-2532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2016 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
76374 | MA SPEECH LANGUAGE PATHOLOGY (01) | MA |