Provider Demographics
NPI:1568708220
Name:SMITH, TERESA (AUD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:WALLBROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163
Mailing Address - Country:US
Mailing Address - Phone:317-620-1897
Mailing Address - Fax:
Practice Address - Street 1:6375 W US 52
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-9750
Practice Address - Country:US
Practice Address - Phone:317-650-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002144A237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter