Provider Demographics
NPI:1023194099
Name:GLEASON, TERRI LYNNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNNE
Last Name:GLEASON
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 1:109 POPLAR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PLAINS
Mailing Address - State:IL
Mailing Address - Zip Code:62677-3445
Mailing Address - Country:US
Mailing Address - Phone:217-416-1771
Mailing Address - Fax:217-626-2223
Practice Address - Street 1:109 POPLAR
Practice Address - Street 2:
Practice Address - City:PLEASANT PLAINS
Practice Address - State:IL
Practice Address - Zip Code:62677-3445
Practice Address - Country:US
Practice Address - Phone:217-416-1771
Practice Address - Fax:217-626-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-006315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist