MEDICARE: CARMEN LYNNETTE TIBBS M.H.S., SLP-CCC

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	309109	KY
2	222Q00000X	Developmental Therapist	CT32520898P	IL
3	235Z00000X	Speech-Language Pathologist	6836	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6836	OTHER	TN	STATE OF TENNESSEE
2	CT32520898P	OTHER	IL	PART C EI CREDENTIAL
3	309109	OTHER	KY	STATE OF KENTUCKY

General Provider Information

NPI Number	:	1639371222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN LYNNETTE TIBBS M.H.S., SLP-CCC

Provider Business Mailing Address
First Line	:	725 GLEASON DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-1123
Country	:	US
Telephone Number	:	931-401-6776
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 GLEASON DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-1123
Country	:	US
Telephone Number	:	931-401-6776
Fax Number	:

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	06/11/2026

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Directions to “ CARMEN LYNNETTE TIBBS M.H.S., SLP-CCC” Practice Location

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