Provider Demographics
NPI:1497497499
Name:WILLIARD, KARLY MAE
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:MAE
Last Name:WILLIARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MAKANDA
Mailing Address - State:IL
Mailing Address - Zip Code:62958-2026
Mailing Address - Country:US
Mailing Address - Phone:618-534-5067
Mailing Address - Fax:
Practice Address - Street 1:792 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1627
Practice Address - Country:US
Practice Address - Phone:618-833-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist