Provider Demographics
NPI:1407157076
Name:BLAESSER, THERESA (SLP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:BLAESSER
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 1:26 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4338
Mailing Address - Country:US
Mailing Address - Phone:973-535-0895
Mailing Address - Fax:
Practice Address - Street 1:66 W MOUNT PLEASANT AVE
Practice Address - Street 2:203
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2900
Practice Address - Country:US
Practice Address - Phone:973-994-4468
Practice Address - Fax:973-994-4412
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00463900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist