Provider Demographics
NPI:1649890377
Name:WATERMAN SPEECH-LANGUAGE PATHOLOGY, PLLC
Entity type:Organization
Organization Name:WATERMAN SPEECH-LANGUAGE PATHOLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:TERRANOVA
Authorized Official - Last Name:WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP, MS, CCC
Authorized Official - Phone:615-482-3253
Mailing Address - Street 1:4731 TROUSDALE DR STE 13A
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-1331
Mailing Address - Country:US
Mailing Address - Phone:615-484-2486
Mailing Address - Fax:615-678-4368
Practice Address - Street 1:4731 TROUSDALE DR STE 13A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1331
Practice Address - Country:US
Practice Address - Phone:615-484-2486
Practice Address - Fax:615-678-4368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty