Provider Demographics
NPI:1225248859
Name:WILLARD, KIMBERLY JOY (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JOY
Last Name:WILLARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:BURDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP/L
Mailing Address - Street 1:6022 TROUT LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-4559
Mailing Address - Country:US
Mailing Address - Phone:630-347-8181
Mailing Address - Fax:
Practice Address - Street 1:1219 S ROOSEVELT ROAD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-4046
Practice Address - Country:US
Practice Address - Phone:708-531-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146.008676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist