Provider Demographics
NPI:1578687455
Name:JAVIER, THERESA BACALA (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:BACALA
Last Name:JAVIER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:B
Other - Last Name:JAVIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0329
Mailing Address - Fax:502-588-0326
Practice Address - Street 1:601 S FLOYD ST
Practice Address - Street 2:STE 500
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1835
Practice Address - Country:US
Practice Address - Phone:502-588-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003679A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200730660AOtherINDIANA FIRST STEPS