Provider Demographics
NPI:1699588491
Name:PARIT MORTEM SPEECH AND LANGUAGE
Entity type:Organization
Organization Name:PARIT MORTEM SPEECH AND LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOSEPHINE
Authorized Official - Last Name:WIENCKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-834-1394
Mailing Address - Street 1:3566 FOXFIELD TRL
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-3004
Mailing Address - Country:US
Mailing Address - Phone:901-834-1394
Mailing Address - Fax:
Practice Address - Street 1:3566 FOXFIELD TRL
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-3004
Practice Address - Country:US
Practice Address - Phone:901-834-1394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty