Provider Demographics
NPI:1174145072
Name:TELE TN SPEECH THERAPY
Entity type:Organization
Organization Name:TELE TN SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP AND MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:615-495-7270
Mailing Address - Street 1:113 BEULAH BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-9790
Mailing Address - Country:US
Mailing Address - Phone:615-802-8280
Mailing Address - Fax:
Practice Address - Street 1:113 BEULAH BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-9790
Practice Address - Country:US
Practice Address - Phone:615-802-8280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4668OtherSTATE LICENSE - SLP
1811425093OtherMANAGING MEMBER INDIVIDUAL NPI