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General NPI Number Information
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NPI Number | 1942504931
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Entity Type | Individual
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Provider Name | MICHAEL PRATER SLP
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Gender | Male
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 1900 PARR AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-2009
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Country | US
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Telephone | 731-847-7240
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Fax | 731-847-9187
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Provider Business Mailing Address
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Address Line | 755 BROWNS CHURCH RD
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City | JACKSON
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State | TN
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Zip | 38305-9296
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Country | US
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Telephone | 731-307-8642
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Fax |
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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 | 4386
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License Number State | TN
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