Provider Demographics
NPI:1861773756
Name:BESSOM, KATHY K (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:K
Last Name:BESSOM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 ELMHURST DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-4438
Mailing Address - Country:US
Mailing Address - Phone:423-745-6313
Mailing Address - Fax:423-507-8828
Practice Address - Street 1:1901 ELMHURST DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4438
Practice Address - Country:US
Practice Address - Phone:423-745-6313
Practice Address - Fax:423-507-8828
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000000327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist