Provider Demographics
NPI:1972968709
Name:WILLIAMS, TAMARA BRIANA (MS/CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:BRIANA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12315 SARATOGA VIEW CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-8363
Mailing Address - Country:US
Mailing Address - Phone:502-643-4168
Mailing Address - Fax:502-254-8767
Practice Address - Street 1:11901 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1077
Practice Address - Country:US
Practice Address - Phone:502-245-3774
Practice Address - Fax:502-254-8767
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY235200000XMedicaid