Provider Demographics
NPI:1407250145
Name:EASON, KAY D (MED/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:D
Last Name:EASON
Suffix:
Gender:F
Credentials: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 1:521 CORDERS CROSSROADS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6917
Mailing Address - Country:US
Mailing Address - Phone:931-212-3747
Mailing Address - Fax:
Practice Address - Street 1:304 ELK AVE S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3054
Practice Address - Country:US
Practice Address - Phone:931-212-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist