Provider Demographics
NPI:1407061104
Name:SHREWSBURY, TERESSA JEANETTE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERESSA
Middle Name:JEANETTE
Last Name:SHREWSBURY
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 1:212 GRAND TETON WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7639
Mailing Address - Country:US
Mailing Address - Phone:270-779-5307
Mailing Address - Fax:
Practice Address - Street 1:212 GRAND TETON WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7639
Practice Address - Country:US
Practice Address - Phone:270-779-5307
Practice Address - Fax:270-846-4550
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1349OtherFIRST STEPS