Provider Demographics
NPI:1245425487
Name:WILLIAMS, KYM D
Entity type:Individual
Prefix:
First Name:KYM
Middle Name:D
Last Name:WILLIAMS
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 1:435 TATE DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-6051
Mailing Address - Country:US
Mailing Address - Phone:630-779-0383
Mailing Address - Fax:
Practice Address - Street 1:435 TATE DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-6051
Practice Address - Country:US
Practice Address - Phone:630-779-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007955235Z00000X
TN3298235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist