Provider Demographics
NPI:1427214980
Name:KUSSART, TERRI LYNN (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYNN
Last Name:KUSSART
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 NEMO RD
Mailing Address - Street 2:
Mailing Address - City:NEMO
Mailing Address - State:SD
Mailing Address - Zip Code:57759-7618
Mailing Address - Country:US
Mailing Address - Phone:605-390-0833
Mailing Address - Fax:605-578-7583
Practice Address - Street 1:12000 NEMO RD
Practice Address - Street 2:
Practice Address - City:NEMO
Practice Address - State:SD
Practice Address - Zip Code:57759-7618
Practice Address - Country:US
Practice Address - Phone:605-390-0833
Practice Address - Fax:605-578-7583
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist