Provider Demographics
NPI:1952641631
Name:MARSHALL, KELLEY LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:KELLEY
Other - Middle Name:LYNN
Other - Last Name:TARWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:10721 CHAPMAN HWY STE 22
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4767
Mailing Address - Country:US
Mailing Address - Phone:865-579-2293
Mailing Address - Fax:865-579-2295
Practice Address - Street 1:111 SULPHUR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2117
Practice Address - Country:US
Practice Address - Phone:615-896-8046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP 0000004544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12148287OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION CERTIFICATE OF CLINICAL COMPETENCE
TNSP 0000004544OtherSTATE OF TN BOARD OF COMMUNICATION DISORDERS AND SCIENCES