Provider Demographics
NPI:1720358260
Name:CARTER, TERESA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:CARTER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10526 EASTPARK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5804
Mailing Address - Country:US
Mailing Address - Phone:678-777-5711
Mailing Address - Fax:
Practice Address - Street 1:10526 EASTPARK LAKE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5804
Practice Address - Country:US
Practice Address - Phone:678-777-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007607235Z00000X
FLSA15346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist