Provider Demographics
NPI:1871712265
Name:WILLIAMS, CHRISTINA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 PEMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-9421
Mailing Address - Country:US
Mailing Address - Phone:479-871-9820
Mailing Address - Fax:479-203-7400
Practice Address - Street 1:599 N CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-2711
Practice Address - Country:US
Practice Address - Phone:479-871-9820
Practice Address - Fax:479-203-7400
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR1988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158136721Medicaid