Provider Demographics
NPI:1629328562
Name:THERAPY SUCCESS, LLC
Entity Type:Organization
Organization Name:THERAPY SUCCESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:901-596-2747
Mailing Address - Street 1:5120 FOGGY RIVER LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-6261
Mailing Address - Country:US
Mailing Address - Phone:901-596-2747
Mailing Address - Fax:901-207-7189
Practice Address - Street 1:5120 FOGGY RIVER LN
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-6261
Practice Address - Country:US
Practice Address - Phone:901-596-2747
Practice Address - Fax:901-207-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP4043235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1629328562OtherMEDICARE
TNQ004861OtherTENNESSEE TENNCARE/MEDICAID
TNQ004861Medicaid