Basic Information
| Provider Information | |||||||||
| NPI: | 1609961655 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF MEMPHIS, MEMPHIS SPEECH & HEARING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 807 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381055042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016785800 | ||||||||
| FaxNumber: | 9015251282 | ||||||||
| Practice Location | |||||||||
| Address1: | 807 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381055042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016785800 | ||||||||
| FaxNumber: | 9015251282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MENDEL | ||||||||
| AuthorizedOfficialFirstName: | MAURICE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DEAN | ||||||||
| AuthorizedOfficialTelephone: | 9016785800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | X | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 235Z00000X | X | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.