Tracy Hennage, SLP
Individual provider Active NPI Speech-Language Pathologist · Jonesborough, TN
NPI 1396304366 · NPPES record last updated Jun 12, 2019
Key facts
- NPI
- 1396304366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 5623 (TN)
- Practice address
- 120 Newman Rd
Jonesborough, TN 37659-6531 - Phone
- (423) 788-4468
- NPI assigned
- Jun 12, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200731001514 | TN | Practitioner - Qualified Speech Language Pathologist | 2860817228 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5623 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthpro Heritage Rehab & Fitness, LLC | Single Specialty | Current |
Accepting new patients |
| Healthpro Heritage Rehab & Fitness, LLC | Single Specialty | Current |
Accepting new patients |
Locations
960 S Seivers Blvd
Clinton, TN 37716
Phone (865) 270-3178
406 E Mountain View Rd
Johnson City, TN 37601
Phone (423) 218-0323
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist |
235Z00000X | 5623 | TN | Yes |
Addresses
Primary practice location
120 Newman Rd
Jonesborough, TN 37659-6531
Mailing address
120 Newman Rd
Jonesborough, TN 37659-6531
Other providers in Jonesborough, TN
- John Alfred Harris
- Isabelle Harvey
- Kristi Rachelle Hatley
- John Michael Haws
- Kacey Jo Henley
- Lindsay Michelle Huffine
- Rallie Deann Hurley
- Independent Physical Therapy, LLC
- Ingles Markets Inc
- Integrity Healthcare of Jonesborough, LLC
All providers in Jonesborough, TN · Speech-Language Pathologist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.