Provider Demographics
NPI:1336273648
Name:KAHANE, JOEL CARL (PHD)
Entity Type:Individual
Prefix:PROF
First Name:JOEL
Middle Name:CARL
Last Name:KAHANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:7675 WOLF RIVER CIR STE 202
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1747
Practice Address - Country:US
Practice Address - Phone:901-737-3021
Practice Address - Fax:901-737-6063
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP000000570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01922763Medicaid
TN1524074Medicaid
MO1336273648Medicaid
TNSP000000570OtherSTATE LICENSE