MEDICARE: MRS. TAMMY WILLIAMS KOEN 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
1	235Z00000X	Speech-Language Pathologist	2204000416	VA

General Provider Information

NPI Number	:	1609644376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMMY WILLIAMS KOEN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	410 BELLINGTON DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-4950
Country	:	US
Telephone Number	:	985-264-8742
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 BELLINGTON DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37615-4950
Country	:	US
Telephone Number	:	985-264-8742
Fax Number	:

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

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	12/12/2023

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Directions to “ MRS. TAMMY WILLIAMS KOEN MS, CCC-SLP” Practice Location

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