| Doctor Name: | KIMBERLY S WILLIS |
| NPI Number: | 1477662476 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. CCC-SLP |
| License Number: | SA4688 |
| Business Practice Address: | 2532 W Indiantown Rd Ste 2 Jupiter, FL - 334583935 |
| Business Phone Number: | 5617485430 |
| Business Fax Number: | 5617485442 |
| Mailing Address: | 5506 Seagrape Dr, FORT PIERCE |
| State: | FL |
| Postal Code: | 349827403 |
| Phone Number: | 7726318255 |
| Fax Number: | 5617485442 |
| NPI Enumeration Date: | 08/30/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA4688 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |