Healthcare Provider Details

I. General information

NPI: 1164071106
Provider Name (Legal Business Name): ISABELLA KEARNEY M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 WILSON PIKE CIR
BRENTWOOD TN
37027-2745
US

IV. Provider business mailing address

1024 15TH AVE S
NASHVILLE TN
37212-2414
US

V. Phone/Fax

Practice location:
  • Phone: 615-236-6566
  • Fax:
Mailing address:
  • Phone: 615-708-0056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6324
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: