Provider Demographics
NPI:1003212986
Name:RIEVES, THERESA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:RIEVES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 JANEWAY CT
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-2403
Mailing Address - Country:US
Mailing Address - Phone:336-408-8247
Mailing Address - Fax:
Practice Address - Street 1:106 JANEWAY CT
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2403
Practice Address - Country:US
Practice Address - Phone:336-408-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist