MEDICARE: KENNETH WILLIAMS

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	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1851236178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH WILLIAMS

Provider Business Mailing Address
First Line	:	553 BLUEBIRD DR
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4878
Country	:	US
Telephone Number	:	630-209-2331
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 N HAMMES AVE STE 1A
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60435-8113
Country	:	US
Telephone Number	:	815-290-0902
Fax Number	:	509-753-2503

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

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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