Provider Demographics
NPI:1821129784
Name:CLEMENT, TERESA NAVE (CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:NAVE
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 RICH CIR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-2746
Mailing Address - Country:US
Mailing Address - Phone:423-581-0533
Mailing Address - Fax:
Practice Address - Street 1:5250 WEST ANDREW JOHNSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814
Practice Address - Country:US
Practice Address - Phone:423-318-7800
Practice Address - Fax:423-317-3332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2030235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4113980OtherBCBS PROVIDER NUMBER
TN5440976Medicaid