Healthcare Provider Details

I. General information

NPI: 1194904342
Provider Name (Legal Business Name): WEST TENNESSEE HEARING & SPEECH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 RIDGECREST RD
JACKSON TN
38305-2359
US

IV. Provider business mailing address

65 RIDGECREST RD
JACKSON TN
38305-2359
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-6076
  • Fax: 731-668-7033
Mailing address:
  • Phone: 731-668-6076
  • Fax: 731-668-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number0000002395
License Number StateTN

VIII. Authorized Official

Name: KIMBERLI MOORE
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, CCC-SLP
Phone: 731-668-6076