MEDICARE: MRS. CARRIE S. MCDERMITT MS,CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2426	TN

General Provider Information

NPI Number	:	1265647085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE S. MCDERMITT MS,CCC-SLP

Provider Business Mailing Address
First Line	:	209 MOCKINGBIRD PLACE
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659
Country	:	US
Telephone Number	:	423-741-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	4825 ANDREW JOHNSON HIGHWAY
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37743
Country	:	US
Telephone Number	:	423-787-6800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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