Provider Demographics
NPI:1922474493
Name:GENEVIEVE THERAPY SERVICES
Entity Type:Organization
Organization Name:GENEVIEVE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMEKO
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-300-7400
Mailing Address - Street 1:470 N PARKWAY STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2843
Mailing Address - Country:US
Mailing Address - Phone:731-300-7400
Mailing Address - Fax:731-300-7224
Practice Address - Street 1:470 N PARKWAY STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2843
Practice Address - Country:US
Practice Address - Phone:731-300-7400
Practice Address - Fax:731-300-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty