Provider Demographics
NPI:1083769392
Name:BRITT, TERESA ANN (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANN
Last Name:BRITT
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 STONEWOOD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-9107
Mailing Address - Country:US
Mailing Address - Phone:870-892-9261
Mailing Address - Fax:870-892-9261
Practice Address - Street 1:113 STONEWOOD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-9107
Practice Address - Country:US
Practice Address - Phone:870-892-9261
Practice Address - Fax:870-892-9261
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR772235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122923721Medicaid