Provider Demographics
NPI:1225222359
Name:WILLINGHAM, REBECCA TAYLOR
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:TAYLOR
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 WEST RD
Mailing Address - Street 2:
Mailing Address - City:BYROMVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31007-3501
Mailing Address - Country:US
Mailing Address - Phone:229-268-8696
Mailing Address - Fax:
Practice Address - Street 1:204 W UNION ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:GA
Practice Address - Zip Code:31092-1056
Practice Address - Country:US
Practice Address - Phone:229-268-4725
Practice Address - Fax:229-268-1567
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP 000079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist