MEDICARE: MS. TAMMY RALLIS MS SLP/CCC

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	18408	TX

General Provider Information

NPI Number	:	1821775651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY RALLIS MS SLP/CCC

Provider Business Mailing Address
First Line	:	2120 INDIAN ST
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-6823
Country	:	US
Telephone Number	:	940-704-5009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1713 WILBARGER ST
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-4741
Country	:	US
Telephone Number	:	940-553-1900
Fax Number	:

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

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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