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General NPI Number Information
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NPI Number | 1598201154
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Entity Type | Organization
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Legal Business Name | FOOTHILLS LANGUAGE AND FEEDING, LLC
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 1878 SOUTHCLIFF DR
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City | MARYVILLE
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State | TN
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Zip | 37803-7520
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Country | US
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Telephone | 404-387-3380
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Fax |
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Provider Business Mailing Address
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Address Line | 1878 SOUTHCLIFF DR
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City | MARYVILLE
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State | TN
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Zip | 37803-7520
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Country | US
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Telephone | 404-387-3380
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JENNIFER TERRY
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Credential | MPH, MS, RD, CCC-SLP
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Telephone | 404-387-3380
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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 | SP0000005184
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | SP0000005184
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License Number State | TN
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