Active NPI
Lauren Laethem Broyles, MS, CCC-SLP
- Speech-Language Pathologist
- Knoxville, TN
National Provider Identifier
1407167752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4144
- Practice address
- 1600 Peyton Manning Pass
Knoxville, TN 37996-0001 - Phone
- (865) 974-0658
- NPI assigned
- Jul 1, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 | 4144 | TN | Primary |
Addresses
Primary practice location
1600 Peyton Manning Pass
Knoxville, TN 37996-0001
Mailing address
1025 Harbour Shore Dr
Knoxville, TN 37934-7030
Phone (423) 732-3204
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4144 | TN | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311206400000",
"number": "1407167752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 HARBOUR SHORE DR",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379347030",
"telephone_number": "423-732-3204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 PEYTON MANNING PASS",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379960001",
"telephone_number": "865-974-0658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROYLES",
"first_name": "LAUREN",
"middle_name": "LAETHEM",
"name_prefix": "Mrs.",
"credential": "MS, CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-01",
"last_updated": "2011-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TN",
"license": "4144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.