Active NPI
Kathryn Suzanne Willard, M.A., SLP
- Speech-Language Pathologist
- Mission Viejo, CA
National Provider Identifier
1821389339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 18837
- Practice address
- 23361 Madero Ste 200
Mission Viejo, CA 92691-7952 - Phone
- (949) 581-8239
- Fax
- (949) 859-0849
- NPI assigned
- May 2, 2011
- 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 | 18837 | CA | Primary |
Addresses
Primary practice location
23361 Madero Ste 200
Mission Viejo, CA 92691-7952
Mailing address
1481 Placentia Ave Apt 10
Newport Beach, CA 92663-2754
Phone (949) 581-8239
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)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18837 | CA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The SLP Lab, LLC | Speech-Language Pathologist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Speech-Language Pathologist
- Buena Vista, CO
- NPI 1376276923
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304294400000",
"number": "1821389339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1481 PLACENTIA AVE APT 10",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926632754",
"telephone_number": "949-581-8239",
"fax_number": "949-859-0849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23361 MADERO STE 200",
"city": "MISSION VIEJO",
"state": "CA",
"postal_code": "926917952",
"telephone_number": "949-581-8239",
"fax_number": "949-859-0849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLARD",
"first_name": "KATHRYN",
"middle_name": "SUZANNE",
"credential": "M.A., SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-02",
"last_updated": "2011-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "18837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mission Viejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.