Healthcare Provider Details

I. General information

NPI: 1801109616
Provider Name (Legal Business Name): MARY TJADER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY BRUCE

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 ASPEN GROVE DR STE 105
FRANKLIN TN
37067-2905
US

IV. Provider business mailing address

9365 ANSLEY LN
BRENTWOOD TN
37027-3309
US

V. Phone/Fax

Practice location:
  • Phone: 615-656-1109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001348
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: