Jayna Nichole Willis, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

142455 Issued in KY

Practice address

1381 Campbell LN
Bowling Green, KY 42104-1049

Phone

(270) 843-0587

NPI assigned

Dec 4, 2017

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512345600000",
    "number": "1447765136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 W MCLELLAN RD",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421018891",
            "telephone_number": "270-784-7690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1381 CAMPBELL LN",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421041049",
            "telephone_number": "270-843-0587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JAYNA",
        "middle_name": "NICHOLE",
        "name_prefix": "Mrs.",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-04",
        "last_updated": "2017-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "142455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Anthony Williams, D.M.D.
• Amanda Leona Williamson
• Kayla Williamson, MD
• Chad Willis, M.D.
• Jana Willis, MS RD LDN
• Jeramy C. Willis, KCSA
• Susan Emily Willis
• Tammy L Willis, DMD
• Kevin Willoughby, LCSW
• Steffan Willoughby, PEER SUPPORT SPEC.

• Speech-Language Pathologist in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Speech-Language Pathologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.