Provider Demographics
NPI:1902022932
Name:DAVIDSON, TERESA JANE (MA CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:JANE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:JANE
Other - Last Name:BRANSCOMBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:411 SW 24TH STREET
Mailing Address - Street 2:HARRY JERSIG CENTER OUR LADY OF THE LAKE UNIVERSITY
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-4689
Mailing Address - Country:US
Mailing Address - Phone:210-434-6711
Mailing Address - Fax:210-434-9360
Practice Address - Street 1:411 SW 24TH STREET
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-4689
Practice Address - Country:US
Practice Address - Phone:210-434-6711
Practice Address - Fax:210-434-9360
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11597235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87862TOtherBCBS TX