Provider Demographics
NPI:1639368830
Name:CLEARLY SPEAKING SPEECH PATHOLOGY SERVICES
Entity Type:Organization
Organization Name:CLEARLY SPEAKING SPEECH PATHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:865-686-0082
Mailing Address - Street 1:2900 TAZEWELL PIKE
Mailing Address - Street 2:STE. G
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1880
Mailing Address - Country:US
Mailing Address - Phone:865-686-0082
Mailing Address - Fax:865-686-0174
Practice Address - Street 1:2900 TAZEWELL PIKE
Practice Address - Street 2:STE. G
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1880
Practice Address - Country:US
Practice Address - Phone:865-686-0082
Practice Address - Fax:865-686-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441762Medicaid