Provider Demographics
NPI:1790015204
Name:VALADA, TERI JO
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:JO
Last Name:VALADA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TERI
Other - Middle Name:JO
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3890 BEACON RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5344
Mailing Address - Country:US
Mailing Address - Phone:352-217-3926
Mailing Address - Fax:
Practice Address - Street 1:3890 BEACON RIDGE WAY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5344
Practice Address - Country:US
Practice Address - Phone:352-217-3926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist