Kathleen Anne Willis, MA CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA7131 Issued in FL

Practice address

6508 Gunn Hwy
Tampa, FL 33625-4022

Phone

(813) 963-6923

Fax

(813) 264-0768

NPI assigned

Jan 11, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Kathleen Anne Fisk Former name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kernaghan and Moore Speech and Language Therapy Services, Inc.Group PAC ID 2365594579, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kernaghan and Moore: Speech and Language Therapy Services, Inc.

  • Speech-Language Pathologist
  • New Port Richey, FL
  • NPI 1467693192
  Medicare reassignment Care Compare group NPD
• Independent Living Inc.

  • Speech-Language Pathologist
  • Tampa, FL
  • NPI 1124072947
  NPD (past)
• Independent Living Inc.

  • Behavior Analyst
  • Tampa, FL
  • NPI 1750156519
  NPD (past)
• Kernaghan and Moore: Speech and Language Therapy Services, Inc.

  • Speech-Language Pathologist
  • Spring Hill, FL
  • NPI 1033888318
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003966193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6508 GUNN HWY",
            "address_2": "INDEPENDENT LIVING INC",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336254022",
            "telephone_number": "813-963-6923",
            "fax_number": "813-264-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6508 GUNN HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336254022",
            "telephone_number": "813-963-6923",
            "fax_number": "813-264-0768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "KATHLEEN",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "MA CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA7131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "FISK",
            "middle_name": "ANNE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cornell Willins Jr.
• Adam Willis, MD
• Adam Christopher Willis, DC
• Andrew John Willis, DC
• Kara Christine Willis, LMHC, LMFT
• Lorena Willis
• Wendy Willis
• Amy Lynn Willitzer, A.R.N.P.
• Martin Anthony Willmitch, D.C.
• Kathleen Willoughby

• Speech-Language Pathologist in Tampa, FL
• Providers in Tampa, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.