Healthcare Provider Details

I. General information

NPI: 1194900977
Provider Name (Legal Business Name): TALKBACK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2007
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WESLEY ST SUITE 8
JOHNSON CITY TN
37601-1740
US

IV. Provider business mailing address

302 WESLEY ST SUITE 8
JOHNSON CITY TN
37601-1740
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-1700
  • Fax:
Mailing address:
  • Phone: 423-282-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7804
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2000
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3838
License Number StateTN

VIII. Authorized Official

Name: ASHLEY CLARK MORRIS
Title or Position: PRESIDENT
Credential: MSP, CCC/SLP
Phone: 423-282-1700