Provider Demographics
NPI:1326009242
Name:WILLIS, KATHERINE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:L
Last Name:WILLIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:K
Other - Middle Name:LEE
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:313 STEEPHILL ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5853
Mailing Address - Country:US
Mailing Address - Phone:434-293-9820
Mailing Address - Fax:
Practice Address - Street 1:313 STEEPHILL ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5853
Practice Address - Country:US
Practice Address - Phone:434-293-9820
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003307103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist