Provider Demographics
NPI:1164755922
Name:REED, TERESA LUCILLE
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LUCILLE
Last Name:REED
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 1:1530 PENNSYLVANIA AVE
Mailing Address - Street 2:APT 7D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2617
Mailing Address - Country:US
Mailing Address - Phone:347-512-2807
Mailing Address - Fax:
Practice Address - Street 1:1530 PENNSYLVANIA AVE
Practice Address - Street 2:APT 7D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2617
Practice Address - Country:US
Practice Address - Phone:347-512-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist