Provider Demographics
NPI:1659914422
Name:THOMPSON, TEIRRAL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TEIRRAL
Middle Name:
Last Name:THOMPSON
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 1:1290 E NINE MILE RD STE B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-1653
Mailing Address - Country:US
Mailing Address - Phone:850-857-9343
Mailing Address - Fax:844-848-7557
Practice Address - Street 1:1290 E NINE MILE RD STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-1653
Practice Address - Country:US
Practice Address - Phone:850-857-9343
Practice Address - Fax:844-848-7557
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17484235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist