Healthcare Provider Details

I. General information

NPI: 1770911083
Provider Name (Legal Business Name): HILARY SHANK GEDGE M.ED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 CROSSROADS BLVD
BRENTWOOD TN
37027-2806
US

IV. Provider business mailing address

300 MILL RUN CIR
NASHVILLE TN
37221-4036
US

V. Phone/Fax

Practice location:
  • Phone: 615-260-3190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-9427
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: