Healthcare Provider Details

I. General information

NPI: 1982927091
Provider Name (Legal Business Name): TARA C WILLIAMS SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 IH 35 N STE Q
ROUND ROCK TX
78681-4204
US

IV. Provider business mailing address

1208 IH 35 N STE Q
ROUND ROCK TX
78681-4204
US

V. Phone/Fax

Practice location:
  • Phone: 512-310-7665
  • Fax: 512-310-9228
Mailing address:
  • Phone: 512-310-7665
  • Fax: 512-310-9228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number35085
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: