Provider Demographics
NPI:1801010186
Name:JEFFERSON, CASWELL MILES III (SLP)
Entity Type:Individual
Prefix:MR
First Name:CASWELL
Middle Name:MILES
Last Name:JEFFERSON
Suffix:III
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3601 THE VANDERBILT CLINIC
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2940
Practice Address - Country:US
Practice Address - Phone:615-322-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006493235Z00000X
TN0000004021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA571152749OtherTRICARE
GA571152749OtherUNITED HEALTH CARE
GA571152749OtherMUTUAL OMAHA
GA571152749OtherAETNA
GA766969817AOtherPEACHSTATE
GAPENDINGOtherWELLCARE
GA571152749OtherBCBS
GA766969817AMedicaid
GA571152749OtherCOVENTRY