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NPI Code Detail

MEDICARE: LINDA WILLIS MS CCC/SLP

MEDICARE: LINDA WILLIS MS 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 Pathologist101295TX

General Provider Information

NPI Number : 1306379318
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA WILLIS MS CCC/SLP
Provider Business Mailing Address
First Line : 5100 RANDOL MILL RD
Second Line :
City : FT WORTH
State : TX
Zip : 76112-1553
Country : US
Telephone Number : 817-548-3258
Fax Number :
Provider Business Practice Location Address
First Line : 5100 RANDOL MILL RD
Second Line :
City : FT WORTH
State : TX
Zip : 76112-1553
Country : US
Telephone Number : 817-548-3258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2017
Last Update Date : 04/06/2017

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Directions to “ LINDA WILLIS MS CCC/SLP” Practice Location

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