Basic Information
| Provider Information | |||||||||
| NPI: | 1821129784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMENT | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | NAVE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CCCSLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 RICH CIR | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378142746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235810533 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5250 WEST ANDREW JOHNSON HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233187800 | ||||||||
| FaxNumber: | 4233173332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2030 | TN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 4113980 | 01 | TN | BCBS PROVIDER NUMBER | OTHER | 5440976 | 05 | TN | MEDICAID |