Provider Demographics
NPI:1578391926
Name:WILLIAMSON, KAITLYN MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5813A E PEA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2634
Mailing Address - Country:US
Mailing Address - Phone:304-785-9551
Mailing Address - Fax:
Practice Address - Street 1:12862 STATE ROUTE 180
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-8939
Practice Address - Country:US
Practice Address - Phone:606-928-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
279135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty