MEDICARE: CONNIE SEHORN 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	0000004785	TN

General Provider Information

NPI Number	:	1275941460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE SEHORN CCC-SLP

Provider Business Mailing Address
First Line	:	3336 EARHART RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3726
Country	:	US
Telephone Number	:	615-308-6056
Fax Number	:

Provider Business Practice Location Address
First Line	:	674 E MAIN ST
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2680
Country	:	US
Telephone Number	:	615-265-8753
Fax Number	:

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

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	07/31/2014

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Directions to “ CONNIE SEHORN CCC-SLP” Practice Location

Language	Start Address	Practice Location

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