Doctor Name: | TANYA S WILLIS |
NPI Number: | 1831441146 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 0000001707 |
Business Practice Address: | 10815 Old Highway 64 Bolivar, TN - 380083599 |
Business Phone Number: | 7316582510 |
Business Fax Number: | |
Mailing Address: | 11415 Lake Hardeman Rd, MIDDLETON |
State: | TN |
Postal Code: | 380524237 |
Phone Number: | 7316090238 |
Fax Number: | |
NPI Enumeration Date: | 10/10/2012 |
NPI Last Update Date: | 10/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 0000001707 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |