Provider Demographics
NPI:1730452350
Name:WILLIAMS MONROE, SAMIAYAH LATRICE (MSCCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SAMIAYAH
Middle Name:LATRICE
Last Name:WILLIAMS MONROE
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:MS
Other - First Name:SAMIAYAH
Other - Middle Name:LATRICE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:803 BELLE OAK PARK
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-7030
Mailing Address - Country:US
Mailing Address - Phone:769-218-6484
Mailing Address - Fax:
Practice Address - Street 1:750 AVIGNON DR STE 4
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5157
Practice Address - Country:US
Practice Address - Phone:601-790-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6135235Z00000X
MSS3514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist