MEDICARE: MS. REBECCA TAYLOR WILLINGHAM

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
1	235Z00000X	Speech-Language Pathologist	SLP 000079	GA

General Provider Information

NPI Number	:	1225222359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA TAYLOR WILLINGHAM

Provider Business Mailing Address
First Line	:	3921 WEST RD
Second Line	:
City	:	BYROMVILLE
State	:	GA
Zip	:	31007-3501
Country	:	US
Telephone Number	:	229-268-8696
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 W UNION ST
Second Line	:
City	:	VIENNA
State	:	GA
Zip	:	31092-1056
Country	:	US
Telephone Number	:	229-268-4725
Fax Number	:	229-268-1567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	02/01/2026

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