Provider Demographics
NPI:1508988361
Name:MERCICA, THERESE ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:ANN
Last Name:MERCICA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1703
Mailing Address - Country:US
Mailing Address - Phone:626-932-3439
Mailing Address - Fax:626-358-5083
Practice Address - Street 1:819 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1703
Practice Address - Country:US
Practice Address - Phone:626-932-3439
Practice Address - Fax:626-358-5083
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 11829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist