Provider Demographics
NPI:1780219055
Name:MCHUGH, TERRA RAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:RAE
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:TERRA
Other - Middle Name:RAE
Other - Last Name:FIRTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:418 FOLLY RD. PHC REHAB
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:843-766-3888
Mailing Address - Fax:843-766-3478
Practice Address - Street 1:1423 MAGNOLIA ST STE D
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3516
Practice Address - Country:US
Practice Address - Phone:225-256-6015
Practice Address - Fax:228-206-6978
Is Sole Proprietor?:No
Enumeration Date:2020-03-07
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3952235Z00000X
6853235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist