Provider Demographics
NPI:1619143823
Name:WIMSATT, TERESA RENEE (MS)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:RENEE
Last Name:WIMSATT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 BENT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9200
Mailing Address - Country:US
Mailing Address - Phone:812-923-7713
Mailing Address - Fax:812-923-7728
Practice Address - Street 1:5022 BENT CREEK DR
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9200
Practice Address - Country:US
Practice Address - Phone:812-923-7713
Practice Address - Fax:812-923-7728
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001702A235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist