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General NPI Number Information
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NPI Number | 1801067400
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Entity Type | Individual
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Provider Name | KIMBERLY ANN WILLIAMSON BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 2203 E EMPIRE ST SUITE G
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City | BLOOMINGTON
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State | IL
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Zip | 61704-3706
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Country | US
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Telephone | 309-662-5050
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Fax | 630-303-9704
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Provider Business Mailing Address
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Address Line | 2203 E EMPIRE ST SUITE G
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City | BLOOMINGTON
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State | IL
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Zip | 61704-3706
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Country | US
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Telephone | 309-662-5050
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Fax | 630-303-9704
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-07-3716
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License Number State | IL
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