Healthcare Provider Details

I. General information

NPI: 1245962174
Provider Name (Legal Business Name): JULIA DESMEDT CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 OLD WEISGARBER RD
KNOXVILLE TN
37909-2682
US

IV. Provider business mailing address

1240 OLD WEISGARBER RD
KNOXVILLE TN
37909-2682
US

V. Phone/Fax

Practice location:
  • Phone: 865-621-4249
  • Fax: 865-381-1371
Mailing address:
  • Phone: 865-621-4249
  • Fax: 865-381-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7958
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: