Basic Information
| Provider Information | |||||||||
| NPI: | 1417302605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MICHEAL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MA, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15928 VENTURA BLVD STE 218 | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914364413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185189709 | ||||||||
| FaxNumber: | 7472308320 | ||||||||
| Practice Location | |||||||||
| Address1: | 15928 VENTURA BLVD STE 218 | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914364413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185189709 | ||||||||
| FaxNumber: | 7472308320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2016 | ||||||||
| LastUpdateDate: | 01/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP 21091 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.