Provider Demographics
NPI:1477836088
Name:DEVEREAUX, TERRA LYNNE (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:LYNNE
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:135 IVORY ROAD
Mailing Address - City:FREWSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14738-0690
Mailing Address - Country:US
Mailing Address - Phone:716-569-7031
Mailing Address - Fax:
Practice Address - Street 1:135 IVORY ST
Practice Address - Street 2:
Practice Address - City:FREWSBURG
Practice Address - State:NY
Practice Address - Zip Code:14738-9531
Practice Address - Country:US
Practice Address - Phone:716-569-7031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010502-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist