MEDICARE: DOMINIQUE HERRINGTON

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	0000002136	TN

General Provider Information

NPI Number	:	1912390048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE HERRINGTON

Provider Business Mailing Address
First Line	:	1215 21ST AVE S STE 9211
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-8590
Country	:	US
Telephone Number	:	615-963-5051
Fax Number	:	615-963-5699

Provider Business Practice Location Address
First Line	:	1215 21ST AVE S STE 9211
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-8590
Country	:	US
Telephone Number	:	615-963-5051
Fax Number	:	615-963-5699

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

Provider Enumeration Date	:	03/13/2015
Last Update Date	:	03/13/2015

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Directions to “ DOMINIQUE HERRINGTON ” Practice Location

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