Provider Demographics
NPI:1235435447
Name:WILLARD, KATIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WILLARD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 ALLEN BROOK LN
Mailing Address - Street 2:STERN CENTER FOR LANGUAGE AND LEARN
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9209
Mailing Address - Country:US
Mailing Address - Phone:802-878-2332
Mailing Address - Fax:802-878-0230
Practice Address - Street 1:1011 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-6200
Practice Address - Country:US
Practice Address - Phone:802-295-8773
Practice Address - Fax:802-295-8926
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8006277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist