Provider Demographics
NPI:1871239103
Name:WILLIAMS, LINSEY RAE
Entity type:Individual
Prefix:
First Name:LINSEY
Middle Name:RAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINSEY
Other - Middle Name:
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2616 LANCELOT DR W
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-6556
Mailing Address - Country:US
Mailing Address - Phone:907-385-7923
Mailing Address - Fax:
Practice Address - Street 1:102 10TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5003
Practice Address - Country:US
Practice Address - Phone:907-759-7697
Practice Address - Fax:907-600-5065
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA07372355S0801X
2355S0801X
AK228178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant