Provider Demographics
NPI:1851545941
Name:KONCHAN, TERESA (MACCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:KONCHAN
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 TORY LN
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-2165
Mailing Address - Country:US
Mailing Address - Phone:845-855-0101
Mailing Address - Fax:
Practice Address - Street 1:42 TORY LN
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-2165
Practice Address - Country:US
Practice Address - Phone:845-855-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist