Provider Demographics
NPI:1346519253
Name:DRAINVILLE, TERESA MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:DRAINVILLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:PRUSAK
Other - Last Name:DRAINVILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:2751 AMSDELL RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5803
Mailing Address - Country:US
Mailing Address - Phone:716-926-1730
Mailing Address - Fax:716-646-2207
Practice Address - Street 1:2751 AMSDELL RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5803
Practice Address - Country:US
Practice Address - Phone:716-926-1730
Practice Address - Fax:716-646-2207
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004561-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01390945Medicaid