Provider Demographics
NPI:1194904342
Name:WEST TENNESSEE HEARING & SPEECH CENTER, INC
Entity type:Organization
Organization Name:WEST TENNESSEE HEARING & SPEECH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:731-668-6076
Mailing Address - Street 1:65 RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2359
Mailing Address - Country:US
Mailing Address - Phone:731-668-6076
Mailing Address - Fax:731-668-7033
Practice Address - Street 1:65 RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2359
Practice Address - Country:US
Practice Address - Phone:731-668-6076
Practice Address - Fax:731-668-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002395261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3530285Medicaid