MEDICARE: MS. TERESA NAVE CLEMENT CCCSLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2030	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4113980	OTHER	TN	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821129784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA NAVE CLEMENT CCCSLP

Provider Business Mailing Address
First Line	:	1420 RICH CIR
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-2746
Country	:	US
Telephone Number	:	423-581-0533
Fax Number	:

Provider Business Practice Location Address
First Line	:	5250 WEST ANDREW JOHNSON HIGHWAY
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814
Country	:	US
Telephone Number	:	423-318-7800
Fax Number	:	423-317-3332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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