Provider Demographics
NPI:1083384341
Name:WILLIAMS, TAYLOR (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 ROCKFORD DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7063
Mailing Address - Country:US
Mailing Address - Phone:512-739-7540
Mailing Address - Fax:
Practice Address - Street 1:1812 WELSH AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4800
Practice Address - Country:US
Practice Address - Phone:979-694-5801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist