Individual
MRS. JENNIFER WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
124 KIMBERLY RD, EAST GRANBY, CT 06026-9544
(860) 987-7374
Mailing address
124 KIMBERLY RD, EAST GRANBY, CT 06026-9544
(860) 987-7374
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
004640
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004640
PUBLIC HEALTH
CT
01
—
14072103
ASHA
—
01
—
8901022626
EDUCATOR CERTIFICATION
CT
Enumeration date
06/28/2022
Last updated
06/28/2022
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