Provider Demographics
NPI:1700816451
Name:AMMONS, TERESA TAYLOR (MS,CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:TAYLOR
Last Name:AMMONS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2932 BREEZEWOOD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5505
Mailing Address - Country:US
Mailing Address - Phone:910-423-7234
Mailing Address - Fax:910-423-8213
Practice Address - Street 1:2932 BREEZEWOOD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5505
Practice Address - Country:US
Practice Address - Phone:910-423-7234
Practice Address - Fax:910-423-8213
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC4875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411537Medicaid
NC7411537Medicaid