Provider Demographics
NPI:1487977740
Name:WILLIS, KAREN M (SLP-P)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:M
Last Name:WILLIS
Suffix:
Gender:F
Credentials:SLP-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9887 E 8000S RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ANNE
Mailing Address - State:IL
Mailing Address - Zip Code:60964-4615
Mailing Address - Country:US
Mailing Address - Phone:815-422-0457
Mailing Address - Fax:
Practice Address - Street 1:9887 E 8000S RD
Practice Address - Street 2:
Practice Address - City:SAINT ANNE
Practice Address - State:IL
Practice Address - Zip Code:60964-4615
Practice Address - Country:US
Practice Address - Phone:815-422-0457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL217.0002072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant