Provider Demographics
NPI:1710296868
Name:BECK, TERESA JEAN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:JEAN
Last Name:BECK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:JEAN
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:141 E MADISON AVE APT 300
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4331
Mailing Address - Country:US
Mailing Address - Phone:217-821-2587
Mailing Address - Fax:
Practice Address - Street 1:9300 GREEN PARK RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7211
Practice Address - Country:US
Practice Address - Phone:314-845-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010018937235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist