Healthcare Provider Details

I. General information

NPI: 1659466712
Provider Name (Legal Business Name): SPEECH PATHOLOGY SERVICES OF EAST TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 CHILHOWEE MEDICAL PARK
MARYVILLE TN
37804-5285
US

IV. Provider business mailing address

PO BOX 5209
MARYVILLE TN
37802-5209
US

V. Phone/Fax

Practice location:
  • Phone: 865-982-3400
  • Fax: 865-238-2034
Mailing address:
  • Phone: 865-982-3400
  • Fax: 865-238-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES ANDREW BECKMANN JR.
Title or Position: COO
Credential:
Phone: 865-982-3400