=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851671176
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAWN FRANKS OVERTON MA CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2011
-----------------------------------------------------
Last Update Date | 08/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 S KENTUCKY ST
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37763-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-705-8688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11823 N MONTICELLO DR
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37934-2621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-675-5876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1593
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------