MEDICARE: MRS. KAREN M. WILLIS SLP-P

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	217.000207	IL

General Provider Information

NPI Number	:	1487977740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN M. WILLIS SLP-P

Provider Business Mailing Address
First Line	:	9887 E 8000S RD
Second Line	:
City	:	SAINT ANNE
State	:	IL
Zip	:	60964-4615
Country	:	US
Telephone Number	:	815-422-0457
Fax Number	:

Provider Business Practice Location Address
First Line	:	9887 E 8000S RD
Second Line	:
City	:	SAINT ANNE
State	:	IL
Zip	:	60964-4615
Country	:	US
Telephone Number	:	815-422-0457
Fax Number	:

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

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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