=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114508801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HONEYCOMB SPEECH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2021
-----------------------------------------------------
Last Update Date | 04/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6013 GALLANT LN
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37918-8215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-704-2852
-----------------------------------------------------
Fax | 865-263-8510
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6013 GALLANT LN
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37918-8215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-704-2852
-----------------------------------------------------
Fax | 865-263-8510
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. KENDAL LEIGH MCMAHON
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 918-704-2852
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA3000X
-----------------------------------------------------
Taxonomy Name | Augmentative Communication Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------