Healthcare Provider Details

I. General information

NPI: 1235509282
Provider Name (Legal Business Name): JENNIFER WALKER MIZE MA,CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9126 PICKENS GAP RD
KNOXVILLE TN
37920-9038
US

IV. Provider business mailing address

9126 PICKENS GAP RD
KNOXVILLE TN
37920-9038
US

V. Phone/Fax

Practice location:
  • Phone: 865-804-2874
  • Fax: 865-573-8042
Mailing address:
  • Phone: 865-804-2874
  • Fax: 865-573-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1626
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: