1790952281 NPI number — DR. RHONDA RENEE WILLIAMS ED.D., CCC-SLP

Table of content: DR. RHONDA RENEE WILLIAMS ED.D., CCC-SLP (NPI 1790952281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790952281 NPI number — DR. RHONDA RENEE WILLIAMS ED.D., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
RHONDA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED.D., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATTINGLY
Provider Other First Name:
RHONDA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ED.D., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790952281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 909
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40201-0909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-0329
Provider Business Mailing Address Fax Number:
502-588-0326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 E CHESTNUT ST
Provider Second Line Business Practice Location Address:
STE 710
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-583-8303
Provider Business Practice Location Address Fax Number:
502-584-0302
Provider Enumeration Date:
05/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  1168 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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