Provider Demographics
NPI:1376297929
Name:FUNCTIONAL FEEDING SOLUTIONS
Entity Type:Organization
Organization Name:FUNCTIONAL FEEDING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENA
Authorized Official - Middle Name:LAU
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, CLS
Authorized Official - Phone:423-416-2398
Mailing Address - Street 1:2 WENTWORTH CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2281
Mailing Address - Country:US
Mailing Address - Phone:423-416-2398
Mailing Address - Fax:
Practice Address - Street 1:2 WENTWORTH CT
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2281
Practice Address - Country:US
Practice Address - Phone:423-416-2398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health