Provider Demographics
NPI:1518628791
Name:KETRON, EMILEE ROSE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:ROSE
Last Name:KETRON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTERVIEW DR UNIT 334
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5483
Mailing Address - Country:US
Mailing Address - Phone:423-863-2715
Mailing Address - Fax:
Practice Address - Street 1:400 CENTERVIEW DR UNIT 334
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5483
Practice Address - Country:US
Practice Address - Phone:423-863-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TN14172100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist