Provider Demographics
NPI:1689238727
Name:TESHIMA, TAMIKO E (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TAMIKO
Middle Name:E
Last Name:TESHIMA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10170 DUNCAN LAKE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9413
Mailing Address - Country:US
Mailing Address - Phone:727-807-0511
Mailing Address - Fax:
Practice Address - Street 1:2450 44TH ST SE STE 201
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-9081
Practice Address - Country:US
Practice Address - Phone:616-528-0870
Practice Address - Fax:616-591-5684
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist