Healthcare Provider Details

I. General information

NPI: 1144380007
Provider Name (Legal Business Name): KATHRYN G WYATT CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8694 POPLAR CREEK RD
NASHVILLE TN
37221-3212
US

IV. Provider business mailing address

8694 POPLAR CREEK RD
NASHVILLE TN
37221-3212
US

V. Phone/Fax

Practice location:
  • Phone: 615-454-1097
  • Fax: 855-232-8604
Mailing address:
  • Phone: 154-541-0976
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP14734
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2404
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number25213
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6092
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3368
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: