Provider Demographics
NPI:1073724449
Name:BROBECK, TERESA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:C
Last Name:BROBECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:C
Other - Last Name:RUDKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5815 W UTOPIA RD
Mailing Address - Street 2:ROOM 358
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:623-806-7744
Mailing Address - Fax:623-537-6221
Practice Address - Street 1:5815 W UTOPIA RD
Practice Address - Street 2:ROOM 358
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-806-7744
Practice Address - Fax:623-537-6221
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3371235Z00000X
AZSLP10908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist