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General NPI Number Information
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NPI Number | 1124445630
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Entity Type | Organization
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Legal Business Name | PARKER PEDIATRIC SPEECH SERVICES, LLS
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 7716 ELPINE GRAY DR
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City | ARLINGTON
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State | TN
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Zip | 38002-8529
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Country | US
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Telephone | 901-729-6141
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Fax |
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Provider Business Mailing Address
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Address Line | 7716 ELPINE GRAY DR
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City | ARLINGTON
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State | TN
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Zip | 38002-8529
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Country | US
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Telephone | 901-729-6141
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BLAINE PARKER
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Credential | MS, CCC-SLP
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Telephone | 901-729-6141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4568
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License Number State | TN
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