Provider Demographics
NPI:1114508801
Name:HONEYCOMB SPEECH
Entity Type:Organization
Organization Name:HONEYCOMB SPEECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENDAL
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:918-704-2852
Mailing Address - Street 1:6013 GALLANT LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-8215
Mailing Address - Country:US
Mailing Address - Phone:918-704-2852
Mailing Address - Fax:865-263-8510
Practice Address - Street 1:6013 GALLANT LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-8215
Practice Address - Country:US
Practice Address - Phone:918-704-2852
Practice Address - Fax:865-263-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative Communication
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1508355413Medicaid