Individual
TANYA S WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10815 OLD HIGHWAY 64, BOLIVAR, TN 38008-3599
(731) 658-2510
Mailing address
11415 LAKE HARDEMAN RD, MIDDLETON, TN 38052-4237
(731) 609-0238
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0000001707
TN
Other
Enumeration date
10/10/2012
Last updated
10/10/2012
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