MEDICARE: CONNECTED SPEECH

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	5482	TN

General Provider Information

NPI Number	:	1831563139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTED SPEECH

Provider Business Mailing Address
First Line	:	1227 BROADGATE DR
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6517
Country	:	US
Telephone Number	:	615-567-3914
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 RAND PL STE 2
Second Line	:	@LPG SPORTS ACADEMY
City	:	FRANKLIN
State	:	TN
Zip	:	37064-8949
Country	:	US
Telephone Number	:	615-567-3914
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MRS. STEPHANIE AERTSSENS
Credential	:	M.S. CCC-SLP
Telephone Number	:	615-567-3914

Provider Enumeration Date	:	11/24/2015
Last Update Date	:	07/23/2016

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Directions to “CONNECTED SPEECH ” Practice Location

Language	Start Address	Practice Location

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