Active NPI
Keiann Williams
- Speech-Language Pathologist
- Lake Bluff, IL
National Provider Identifier
1679306948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 217.000495
- Practice address
- 917 Sherwood Dr Ste 201
Lake Bluff, IL 60044-2235 - Phone
- (877) 486-4140
- NPI assigned
- Aug 22, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 217.000495 | IL | Primary |
Addresses
Primary practice location
917 Sherwood Dr Ste 201
Lake Bluff, IL 60044-2235
Mailing address
4419 Raven CT
Gurnee, IL 60031-2745
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 217.000495 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725840000000",
"number": "1679306948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4419 RAVEN CT",
"city": "GURNEE",
"state": "IL",
"postal_code": "600312745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "917 SHERWOOD DR STE 201",
"city": "LAKE BLUFF",
"state": "IL",
"postal_code": "600442235",
"telephone_number": "877-486-4140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "KEIANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-22",
"last_updated": "2024-09-09",
"certification_date": "2024-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "217.000495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Bluff, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.