Provider Demographics
NPI:1083941736
Name:CLEMENTS, TERRI ANNE
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:ANNE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 KENDALL AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2854
Mailing Address - Country:US
Mailing Address - Phone:601-600-2633
Mailing Address - Fax:601-385-1626
Practice Address - Street 1:318 KENDALL AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2854
Practice Address - Country:US
Practice Address - Phone:601-600-2633
Practice Address - Fax:601-385-1626
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSSO388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist