Provider Demographics
NPI:1093738577
Name:HATHORNE, HOWELL F (MSCCC SLP)
Entity Type:Individual
Prefix:
First Name:HOWELL
Middle Name:F
Last Name:HATHORNE
Suffix:
Gender:M
Credentials:MSCCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3638
Mailing Address - Country:US
Mailing Address - Phone:423-837-9500
Mailing Address - Fax:423-837-3272
Practice Address - Street 1:1000 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3638
Practice Address - Country:US
Practice Address - Phone:423-837-9500
Practice Address - Fax:423-837-3272
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3054468OtherBCBST
TN3054468Medicaid
TN3054468Medicaid