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General NPI Number Information
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NPI Number | 1629426143
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Entity Type | Organization
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Legal Business Name | SPEECH PATHOLOGY ASSOCIATES
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 127 S KENTUCKY ST
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City | KINGSTON
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State | TN
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Zip | 37763-2746
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Country | US
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Telephone | 865-604-4446
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 GLENNSHIRE DR
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City | KNOXVILLE
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State | TN
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Zip | 37923-1958
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | JAN FINE
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Credential | M.A. CCC-SLP
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Telephone | 865-705-8688
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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 | 5512
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License Number State | TN
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