Provider Demographics
NPI:1710145107
Name:ANDERLE, TERESA RENAE (MS, CCC / SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:RENAE
Last Name:ANDERLE
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 1:113 VILLAGE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7118
Mailing Address - Country:US
Mailing Address - Phone:469-222-3598
Mailing Address - Fax:
Practice Address - Street 1:100 COOKE ST
Practice Address - Street 2:
Practice Address - City:NOCONA
Practice Address - State:TX
Practice Address - Zip Code:76255-2108
Practice Address - Country:US
Practice Address - Phone:940-825-5061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004228503Medicaid
TX8ES492OtherBLUE CROSS BLUE SHIELD