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NPI Code Detail

MEDICARE: TAMARA WILLIARD SLP,MA,CCC-SLP

MEDICARE: TAMARA WILLIARD SLP,MA,CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist19233TX

General Provider Information

NPI Number : 1144361502
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA WILLIARD SLP,MA,CCC-SLP
Provider Business Mailing Address
First Line : 1919 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1358
Country : US
Telephone Number : 940-595-1859
Fax Number :
Provider Business Practice Location Address
First Line : 1919 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1358
Country : US
Telephone Number : 940-595-1859
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 03/21/2014

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Directions to “ TAMARA WILLIARD SLP,MA,CCC-SLP” Practice Location

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