=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407075765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SPEECH LANGUAGE READING CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 08/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 MOUNTAIN CREEK RD SUITE 380
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37405-1687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-877-5042
-----------------------------------------------------
Fax | 423-877-5046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 MOUNTAIN CREEK RD SUITE 380
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37405-1687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-877-5042
-----------------------------------------------------
Fax | 423-877-5046
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MR. HARRY DALTON BURROUGHS JR.
-----------------------------------------------------
Credential | M.S.
-----------------------------------------------------
Telephone | 423-877-5042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP549
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------