Provider Demographics
NPI:1629586425
Name:TELLER, KAREN MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:TELLER
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 1:1517 GREEN EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6119
Mailing Address - Country:US
Mailing Address - Phone:919-453-8610
Mailing Address - Fax:
Practice Address - Street 1:2275 RUIN CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537-8732
Practice Address - Country:US
Practice Address - Phone:252-492-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist