Provider Demographics
NPI:1942559042
Name:WILLIAMS, KATHRYN JOANNE (CSCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JOANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CSCD, CCC-SLP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:JOANNE
Other - Last Name:SAMPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1535 FARMERS LANE
Mailing Address - Street 2:#319
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-542-1010
Mailing Address - Fax:707-542-3232
Practice Address - Street 1:1212 COLLEGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-542-1010
Practice Address - Fax:707-542-3232
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist