MEDICARE: KAITLYN MARIE WILLINGHAM M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	40856	TX
2	235Z00000X	Speech-Language Pathologist	120597	TX

General Provider Information

NPI Number	:	1336617141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN MARIE WILLINGHAM M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2605 SPRING SIDE DR
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-6139
Country	:	US
Telephone Number	:	817-675-9381
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 E MAIN ST
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-3713
Country	:	US
Telephone Number	:	469-434-2014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2018
Last Update Date	:	06/27/2025

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Directions to “ KAITLYN MARIE WILLINGHAM M.S., CCC-SLP” Practice Location

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