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General NPI Number Information
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NPI Number | 1194904342
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Entity Type | Organization
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Legal Business Name | WEST TENNESSEE HEARING & SPEECH CENTER, INC
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 65 RIDGECREST RD
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City | JACKSON
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State | TN
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Zip | 38305-2359
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Country | US
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Telephone | 731-668-6076
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Fax | 731-668-7033
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Provider Business Mailing Address
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Address Line | 65 RIDGECREST RD
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City | JACKSON
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State | TN
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Zip | 38305-2359
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Country | US
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Telephone | 731-668-6076
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Fax | 731-668-7033
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIMBERLI MOORE
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Credential | MS, CCC-SLP
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Telephone | 731-668-6076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 0000002395
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License Number State | TN
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