Provider Demographics
NPI:1407938327
Name:NERI, THERESE P (CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:THERESE
Middle Name:P
Last Name:NERI
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:MS
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:CHEVALIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3100 SHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143
Mailing Address - Country:US
Mailing Address - Phone:715-732-5111
Mailing Address - Fax:715-732-0628
Practice Address - Street 1:3117 SHORE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143
Practice Address - Country:US
Practice Address - Phone:715-732-5111
Practice Address - Fax:715-732-0628
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI326154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42714800Medicaid
WI42714800Medicaid