Provider Demographics
NPI:1447397351
Name:WILLIAMS, CHRYSTAL INGRAM (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:INGRAM
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-0244
Mailing Address - Country:US
Mailing Address - Phone:919-528-4474
Mailing Address - Fax:919-528-4478
Practice Address - Street 1:1555 HWY 56
Practice Address - Street 2:UNIT 4
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-8296
Practice Address - Country:US
Practice Address - Phone:919-528-4474
Practice Address - Fax:919-528-4478
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412426Medicaid
NC141NCOtherBLUE CROSS BLUE SHIELD