Basic Information
| Provider Information | |||||||||
| NPI: | 1437223096 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | MAR | ||||||||
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| Credential: | MS CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55 | ||||||||
| Address2: | 4604 WEST RIPPLE DRIVE | ||||||||
| City: | WEST JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012820954 | ||||||||
| FaxNumber: | 8019552540 | ||||||||
| Practice Location | |||||||||
| Address1: | 6246 S REDWOOD ROAD | ||||||||
| Address2: | AVALON BENNION CARE CENTER | ||||||||
| City: | TAYLORSVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019691420 | ||||||||
| FaxNumber: | 8019552540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 4950184-4102 | UT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | D4215 | 05 | UT | MEDICAID |