Provider Demographics
NPI:1689627952
Name:HAFF, TERESA ELIZABETH (MCD CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ELIZABETH
Last Name:HAFF
Suffix:
Gender:F
Credentials:MCD CCC-SLP
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:ELIZABETH
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:289 COUNTY ROAD 746
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-0247
Mailing Address - Country:US
Mailing Address - Phone:870-897-7867
Mailing Address - Fax:870-418-0791
Practice Address - Street 1:339 HIGHWAY 463 N
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-3505
Practice Address - Country:US
Practice Address - Phone:870-418-0794
Practice Address - Fax:870-418-0791
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137022721Medicaid
AR5W219OtherBLUE CROSS BLUE SHIELD #