Provider Demographics
NPI:1003932435
Name:REINOSO, TERRI J (SLP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:J
Last Name:REINOSO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7232 BOSTON HARBOR RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-1845
Mailing Address - Country:US
Mailing Address - Phone:360-339-2314
Mailing Address - Fax:360-705-9015
Practice Address - Street 1:703 LILLY RD NE STE 104
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5191
Practice Address - Country:US
Practice Address - Phone:360-339-2314
Practice Address - Fax:360-705-9015
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8407157Medicaid