Provider Demographics
NPI:1376758599
Name:STILES, TERESA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:STILES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 HUNTLEY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1079
Mailing Address - Country:US
Mailing Address - Phone:614-840-0588
Mailing Address - Fax:614-840-9310
Practice Address - Street 1:6171 HUNTLEY RD
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1079
Practice Address - Country:US
Practice Address - Phone:614-840-0588
Practice Address - Fax:614-840-9310
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-5599235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist