Active NPI
Kaitlin Henderson
- Speech-Language Pathologist
- Clarksville, TN
National Provider Identifier
1053147157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 8792
- Practice address
- 621 Gracey Ave
Clarksville, TN 37040-4012 - Phone
- (931) 648-5600
- NPI assigned
- Sep 13, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 8792 | TN | Primary |
Addresses
Primary practice location
621 Gracey Ave
Clarksville, TN 37040-4012
Mailing address
545 Mainstream Dr Ste 220
Nashville, TN 37228-1261
Phone (615) 983-5300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8792 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726185600000",
"number": "1053147157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "545 MAINSTREAM DR STE 220",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372281261",
"telephone_number": "615-983-5300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 GRACEY AVE",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370404012",
"telephone_number": "931-648-5600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "KAITLIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-13",
"last_updated": "2024-09-13",
"certification_date": "2024-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TN",
"license": "8792",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.