Active NPI
Jennifer Williams, CCC-SLP
- Speech-Language Pathologist
- East Granby, CT
National Provider Identifier
1740912856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 004640
- Practice address
- 124 Kimberly Rd
East Granby, CT 06026-9544 - Phone
- (860) 987-7374
- NPI assigned
- Jun 28, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 004640 | CT | Primary |
Addresses
Primary practice location
124 Kimberly Rd
East Granby, CT 06026-9544
Mailing address
124 Kimberly Rd
East Granby, CT 06026-9544
Phone (860) 987-7374
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8901022626 | Other | CT | EDUCATOR CERTIFICATION |
| 004640 | Other | CT | PUBLIC HEALTH |
| 14072103 | Other | ASHA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004640 | CT | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656374400000",
"number": "1740912856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 KIMBERLY RD",
"city": "EAST GRANBY",
"state": "CT",
"postal_code": "060269544",
"telephone_number": "860-987-7374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 KIMBERLY RD",
"city": "EAST GRANBY",
"state": "CT",
"postal_code": "060269544",
"telephone_number": "860-987-7374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-28",
"last_updated": "2022-06-28",
"certification_date": "2022-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CT",
"license": "004640",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EDUCATOR CERTIFICATION",
"identifier": "8901022626",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PUBLIC HEALTH",
"identifier": "004640",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA",
"identifier": "14072103",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in East Granby, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.