Provider Demographics
NPI:1356689756
Name:WILLIAMS, KATIE ELIZABETH (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:ELIZABETH
Other - Last Name:ZINGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:533 E RIVERSIDE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6621
Mailing Address - Country:US
Mailing Address - Phone:714-616-9572
Mailing Address - Fax:
Practice Address - Street 1:533 E RIVERSIDE DR STE 102
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6621
Practice Address - Country:US
Practice Address - Phone:208-992-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8125235Z00000X
IDSP-4230235Z00000X
IDSLP-4230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist