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General NPI Number Information
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NPI Number | 1437549219
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Entity Type | Individual
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Provider Name | HEATHER M FANNIN M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 711 EASTGATE LOOP
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City | CHATTANOOGA
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State | TN
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Zip | 37411-5691
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Country | US
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Telephone | 423-380-8276
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8213
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City | CHATTANOOGA
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State | TN
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Zip | 37414-0213
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Country | US
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Telephone | 423-680-7247
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Fax | 423-208-9223
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0000003782
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License Number State | TN
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