Provider Demographics
NPI:1093324261
Name:MOMENTUM SPEECH THERAPY OF KNOXVILLE, LLC
Entity Type:Organization
Organization Name:MOMENTUM SPEECH THERAPY OF KNOXVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:865-470-4131
Mailing Address - Street 1:9111 CROSS PARK DR STE D200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4521
Mailing Address - Country:US
Mailing Address - Phone:865-470-4131
Mailing Address - Fax:865-221-8109
Practice Address - Street 1:9111 CROSS PARK DR STE D200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4521
Practice Address - Country:US
Practice Address - Phone:865-470-4131
Practice Address - Fax:865-221-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty