MEDICARE: SOUTHEAST SPEECH SERVICES

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

General Provider Information

NPI Number	:	1528809613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST SPEECH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 32665
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37930-2665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2482 BRIGHTS PIKE
Second Line	:
City	:	MORRISTOWN
State	:	TN
Zip	:	37814-6315
Country	:	US
Telephone Number	:	865-312-8220
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHAD SZALA
Credential	:	BCBA
Telephone Number	:	813-598-1337

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	06/04/2024

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Directions to “SOUTHEAST SPEECH SERVICES ” Practice Location

Language	Start Address	Practice Location

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