Provider Demographics
NPI:1598201154
Name:FOOTHILLS LANGUAGE AND FEEDING, LLC
Entity Type:Organization
Organization Name:FOOTHILLS LANGUAGE AND FEEDING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, MS, RD, CCC-SLP
Authorized Official - Phone:404-387-3380
Mailing Address - Street 1:1878 SOUTHCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-7520
Mailing Address - Country:US
Mailing Address - Phone:404-387-3380
Mailing Address - Fax:
Practice Address - Street 1:1878 SOUTHCLIFF DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-7520
Practice Address - Country:US
Practice Address - Phone:404-387-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000005184252Y00000X, 261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech