Provider Demographics
NPI:1326221623
Name:MITZIE MICHELLE SLAYDEN
Entity Type:Organization
Organization Name:MITZIE MICHELLE SLAYDEN
Other - Org Name:SUMMIT AUDIOLOGY & HEARING AID CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MITZIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SLAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:615-889-4105
Mailing Address - Street 1:1313 CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3153
Mailing Address - Country:US
Mailing Address - Phone:615-889-4105
Mailing Address - Fax:615-889-9869
Practice Address - Street 1:1313 CENTRAL CT
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3153
Practice Address - Country:US
Practice Address - Phone:615-889-4105
Practice Address - Fax:615-889-9869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN213237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728019Medicaid
TN3728019Medicaid