Organization
KIDZ ZONE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M. MARSHALL MS, CCC-SLP (SPEECH-LANGUAGE PATHOLGIST)
(423) 318-7800
Entity
Organization
Contact information
Practice address
466A EASTERN PLAZA SHOPPING CTR, NEWPORT, TN 37821-3108
(423) 623-9997
(423) 623-9909
Mailing address
5250 W. ANDREW JOHNSON HWY., MORRISTOWN, TN 37814
(423) 318-7800
(423) 317-3332
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1620
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5440980
—
TN
Enumeration date
05/01/2007
Last updated
06/18/2008
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