Provider Demographics
NPI:1821237538
Name:WILLIAMSON, KYLEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 STERLING ST N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-3611
Mailing Address - Country:US
Mailing Address - Phone:651-702-8428
Mailing Address - Fax:
Practice Address - Street 1:1060 STERLING ST N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55119-3611
Practice Address - Country:US
Practice Address - Phone:651-702-8428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8301235Z00000X
WI3221-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist