Provider Demographics
NPI:1972647949
Name:WILLIAMS, KATHLEEN BOREN (MCSD)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BOREN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MCSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7940
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:407 CANYON CREEK DR
Practice Address - Street 2:SUITE 108
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3291
Practice Address - Country:US
Practice Address - Phone:254-778-3736
Practice Address - Fax:254-771-2629
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51747237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB129395Medicare PIN