Individual
OLISA JEAN HORTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1010 MAIN ST, SURGOINSVILLE, TN 37873-6055
(423) 345-2153
Mailing address
1010 MAIN ST, SURGOINSVILLE, TN 37873-6055
(423) 345-2153
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
2202007107
VA
235Z00000X
Speech-Language Pathologist
Primary
4223
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q000850
—
TN
Enumeration date
03/08/2013
Last updated
02/18/2015
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