Provider Demographics
NPI:1790231124
Name:JEANNINE COUVERTIERE, SLP SERVICES
Entity Type:Organization
Organization Name:JEANNINE COUVERTIERE, SLP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COUVERTIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-548-8053
Mailing Address - Street 1:1025 GARRISON RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5158
Mailing Address - Country:US
Mailing Address - Phone:865-548-8053
Mailing Address - Fax:865-288-0089
Practice Address - Street 1:1025 GARRISON RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5158
Practice Address - Country:US
Practice Address - Phone:865-548-8053
Practice Address - Fax:865-288-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014633Medicaid