=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083358329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEYOND WORDS THERAPY CLINIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2022
-----------------------------------------------------
Last Update Date | 09/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5120 TELECOM DR STE I
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38358-3496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-238-1624
-----------------------------------------------------
Fax | 731-240-8080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5120 TELECOM DR STE I
-----------------------------------------------------
City | MILAN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38358-3496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-238-1624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. KIMBERLI KAYE MOORE
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 731-793-2266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------