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General NPI Number Information
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NPI Number | 1598749822
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Entity Type | Individual
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Provider Name | TAMARA ANN MCKINLEY M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 2600 AERO DRIVE
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City | PORT ARTHUR
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State | TX
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Zip | 77640-1528
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Country | US
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Telephone | 409-972-9222
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Fax | 409-729-2001
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Provider Business Mailing Address
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Address Line | 3312 TERRACE DR
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City | NEDERLAND
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State | TX
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Zip | 77627-6828
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Country | US
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Telephone | 409-724-1331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 102159
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License Number State | TX
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