Provider Demographics
NPI:1649917337
Name:WILLIAMS, JESSICA DAWN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 HIGHWAY 706
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-9784
Mailing Address - Country:US
Mailing Address - Phone:606-616-8706
Mailing Address - Fax:
Practice Address - Street 1:618 HIGHWAY 706
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-9784
Practice Address - Country:US
Practice Address - Phone:606-616-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency