Healthcare Provider Details

I. General information

NPI: 1487707519
Provider Name (Legal Business Name): MARY L EADIE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY L ROSE SLP

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6224 RIVERVALLEY DR
NASHVILLE TN
37221-6576
US

IV. Provider business mailing address

6224 RIVERVALLEY DR
NASHVILLE TN
37221-6576
US

V. Phone/Fax

Practice location:
  • Phone: 615-397-0797
  • Fax:
Mailing address:
  • Phone: 615-397-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 0000002412
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: