Provider Demographics
NPI:1518184134
Name:BERNIARD, TERRY PETERSON (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:PETERSON
Last Name:BERNIARD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SPYGLASS LN
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-6106
Mailing Address - Country:US
Mailing Address - Phone:337-344-1556
Mailing Address - Fax:337-857-9629
Practice Address - Street 1:213 SPYGLASS LN
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-6106
Practice Address - Country:US
Practice Address - Phone:337-344-1556
Practice Address - Fax:337-857-9629
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist