Tanya Williams Clark, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Bainbridge, GA
NPI 1518022425 · NPPES record last updated Jan 24, 2014
Key facts
- NPI
- 1518022425
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP004670 (GA)
- Practice address
- 100 South West St.
Bainbridge, GA 39817 - Phone
- (229) 248-2837
- Fax
- (229) 248-2844
- NPI assigned
- Dec 22, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP004670 | GA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Decatur County Board of Education | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP004670 | GA | Yes |
Addresses
Primary practice location
100 South West St.
Bainbridge, GA 39817
Mailing address
100 South West St.
Bainbridge, GA 39817
Phone (229) 248-2837
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000865664B | Medicaid | GA |
Other providers in Bainbridge, GA
- Larissa Mara Carpenter
- Peter Castoro
- Mariela Castro Salgado
- Shantrice Shena Cheatem
- Clarence E. Bush, D.M.D., P.C.
- Breeanna Cleveland
- Amanda Cochran
- James Sydney Cochran
- Kathryn Culverson Coe
- Bernadine D Collier
All providers in Bainbridge, GA · Speech-Language Pathologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.