Individual
MRS. KACI DAWN WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
110 WILLIS SPRING RD, EAGLETOWN, OK 74734-3413
(870) 784-1147
Mailing address
110 WILLIS SPRING RD, EAGLETOWN, OK 74734-3413
(870) 784-1147
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
112453
TX
235Z00000X
Speech-Language Pathologist
Primary
SP#P9074
AR
Other
Enumeration date
01/18/2017
Last updated
01/18/2017
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