Healthcare Provider Details

I. General information

NPI: 1417864638
Provider Name (Legal Business Name): PATRICIA HENNESSY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 HUTCH CT
GALLATIN TN
37066-1575
US

IV. Provider business mailing address

222 HUTCH CT
GALLATIN TN
37066-1575
US

V. Phone/Fax

Practice location:
  • Phone: 239-600-4596
  • Fax:
Mailing address:
  • Phone: 239-600-4596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number923
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: