Active NPI
Diane Vennessa Davis-Williams, CCC-SLP
- Speech-Language Pathologist
- Matteson, IL
National Provider Identifier
1053519090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 4747 Lincoln Mall Dr
Suite #302
Matteson, IL 60443-3811 - Phone
- (708) 679-0680
- Fax
- (708) 679-0683
- NPI assigned
- Jul 10, 2007
- Last updated
- Jul 10, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | IL | Primary |
Addresses
Primary practice location
4747 Lincoln Mall Dr
Suite #302
Matteson, IL 60443-3811
Mailing address
4747 Lincoln Mall Dr
Suite #302
Matteson, IL 60443-3811
Phone (708) 679-0680
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146-002172 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BNM Professional Consulting Services, Inc. | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Matteson, IL
- NPI 1790795805
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184025600000",
"number": "1053519090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4747 LINCOLN MALL DR",
"address_2": "SUITE #302",
"city": "MATTESON",
"state": "IL",
"postal_code": "604433811",
"telephone_number": "708-679-0680",
"fax_number": "708-679-0683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4747 LINCOLN MALL DR",
"address_2": "SUITE #302",
"city": "MATTESON",
"state": "IL",
"postal_code": "604433811",
"telephone_number": "708-679-0680",
"fax_number": "708-679-0683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS-WILLIAMS",
"first_name": "DIANE",
"middle_name": "VENNESSA",
"name_prefix": "Dr.",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-10",
"last_updated": "2007-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Matteson, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.