Provider Demographics
NPI:1396389631
Name:WILLIAMS, KATHRYN DENISE (MS, CCC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 CALLE VALLARTA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3523
Mailing Address - Country:US
Mailing Address - Phone:949-295-2111
Mailing Address - Fax:
Practice Address - Street 1:30240 RANCHO VIEJO RD STE D
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1515
Practice Address - Country:US
Practice Address - Phone:949-248-7245
Practice Address - Fax:949-248-7845
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2724235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty