Provider Demographics
NPI:1861456915
Name:PITTS, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N LAKEMONT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3228
Mailing Address - Country:US
Mailing Address - Phone:407-644-4883
Mailing Address - Fax:407-644-3697
Practice Address - Street 1:201 N LAKEMONT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3228
Practice Address - Country:US
Practice Address - Phone:407-644-4883
Practice Address - Fax:407-644-3697
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ3773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist