Provider Demographics
NPI:1679193627
Name:PERRY, SIMONE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-5103
Mailing Address - Country:US
Mailing Address - Phone:603-313-6871
Mailing Address - Fax:
Practice Address - Street 1:8120 MCDONALD RD
Practice Address - Street 2:
Practice Address - City:MOHAWK
Practice Address - State:TN
Practice Address - Zip Code:37810-4900
Practice Address - Country:US
Practice Address - Phone:423-235-5406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8249235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist