Provider Demographics
NPI:1164658407
Name:WILLINGHAM, INC., TAMMY KALIKO (MA/SLP/CCC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:KALIKO
Last Name:WILLINGHAM, INC.
Suffix:
Gender:F
Credentials:MA/SLP/CCC
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:KALIKO
Other - Last Name:WILLINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:151 TERRACE SHORES DR
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-2705
Mailing Address - Country:US
Mailing Address - Phone:321-984-2789
Mailing Address - Fax:
Practice Address - Street 1:151 TERRACE SHORES DR
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-2705
Practice Address - Country:US
Practice Address - Phone:321-984-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist