Provider Demographics
NPI:1235891144
Name:CHILDERS, TERRYE D (SPEECH PATHOLOGIST-)
Entity Type:Individual
Prefix:MRS
First Name:TERRYE
Middle Name:D
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5017
Mailing Address - Country:US
Mailing Address - Phone:432-688-9979
Mailing Address - Fax:
Practice Address - Street 1:3517 BOYD AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-6605
Practice Address - Country:US
Practice Address - Phone:432-697-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist