MEDICARE: CAROLINE REMKE LACKEY

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	SP0000005015	TN

General Provider Information

NPI Number	:	1578009650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE REMKE LACKEY

Provider Business Mailing Address
First Line	:	3841 GREEN HILLS VILLAGE DR STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 21ST AVE S
Second Line	:	RM 6352
City	:	NASHVILLE
State	:	TN
Zip	:	37232-8105
Country	:	US
Telephone Number	:	615-936-7929
Fax Number	:

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

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	03/25/2022

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Directions to “ CAROLINE REMKE LACKEY ” Practice Location

Language	Start Address	Practice Location

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