Provider Demographics
NPI:1003423302
Name:DEROUIN, TERESA M (MS)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:DEROUIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 OLYMPIC DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1727
Mailing Address - Country:US
Mailing Address - Phone:253-855-0007
Mailing Address - Fax:
Practice Address - Street 1:HARBOR SPEECH PATHOLOGY
Practice Address - Street 2:463 TREMONT ST W SUITE 110
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366
Practice Address - Country:US
Practice Address - Phone:253-855-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist