MEDICARE: REAGAN WILLIAMSON

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	SZ12639	FL

General Provider Information

NPI Number	:	1487540811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REAGAN WILLIAMSON

Provider Business Mailing Address
First Line	:	8055 FOURTH ST
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-7531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1762 SEA LARK LN
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-7406
Country	:	US
Telephone Number	:	850-204-8030
Fax Number	:

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

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	12/02/2025

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Directions to “ REAGAN WILLIAMSON ” Practice Location

Language	Start Address	Practice Location

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