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NPI Code Detail

MEDICARE: MISS MARY ELLEN LEGG CCC-SLP

MEDICARE: MISS MARY ELLEN LEGG 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
1235Z00000XSpeech-Language PathologistSP3768TN

General Provider Information

NPI Number : 1770880999
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MARY ELLEN LEGG CCC-SLP
Provider Business Mailing Address
First Line : 7901 POPLAR AVE
Second Line :
City : GERMANTOWN
State : TN
Zip : 38138-5006
Country : US
Telephone Number : 901-758-2228
Fax Number : 901-531-6735
Provider Business Practice Location Address
First Line : 7901 POPLAR AVE
Second Line :
City : GERMANTOWN
State : TN
Zip : 38138-5006
Country : US
Telephone Number : 901-758-2228
Fax Number : 901-531-6735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2011
Last Update Date : 02/24/2011

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Directions to “ MISS MARY ELLEN LEGG CCC-SLP” Practice Location

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