Provider Demographics
NPI:1104012152
Name:MEHTA, ANNETTE M (MA, MED,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MA, MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1311
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-1311
Mailing Address - Country:US
Mailing Address - Phone:615-890-0935
Mailing Address - Fax:
Practice Address - Street 1:1840 HERITAGE PARK PLZ
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1575
Practice Address - Country:US
Practice Address - Phone:615-890-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSPOOO212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist