Provider Demographics
NPI:1952549420
Name:GENTRY, PAULETTE WILLIE (SLP)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:WILLIE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 HILLSBORO RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-6223
Mailing Address - Country:US
Mailing Address - Phone:615-591-3244
Mailing Address - Fax:
Practice Address - Street 1:2117 HILLSBORO RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-6223
Practice Address - Country:US
Practice Address - Phone:615-591-3244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist