Provider Demographics
NPI:1144569864
Name:GROVES, TERESA M (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:GROVES
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 BROWNSTONE CT
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-2637
Mailing Address - Country:US
Mailing Address - Phone:724-265-8133
Mailing Address - Fax:
Practice Address - Street 1:1504 BROWNSTONE CT
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-2637
Practice Address - Country:US
Practice Address - Phone:724-265-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005614L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist