Organization
KNOXVILLE INTEGRATED DEVELOPMENTAL SERVICES, INC.
Active
Other names
KIDS Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA RODGERS (HR/IT MANAGER)
(865) 539-1928
Entity
Organization
Contact information
Practice address
9047 EXECUTIVE PARK DR, SUITE 115, KNOXVILLE, TN 37923-4605
(865) 539-1928
(865) 539-6461
Mailing address
9047 EXECUTIVE PARK DR, SUITE 115, KNOXVILLE, TN 37923-4605
(865) 539-1928
(865) 539-6461
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4177096
BCBS
TN
Enumeration date
04/22/2008
Last updated
05/14/2009
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