Provider Demographics
NPI:1902036536
Name:HALSTEAD, TERESA A
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:HALSTEAD
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 1:604 LIBERTY ST
Mailing Address - Street 2:SUITE 229
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1775
Mailing Address - Country:US
Mailing Address - Phone:641-621-1122
Mailing Address - Fax:641-621-1177
Practice Address - Street 1:604 LIBERTY ST
Practice Address - Street 2:SUITE 229
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1775
Practice Address - Country:US
Practice Address - Phone:641-621-1122
Practice Address - Fax:641-621-1177
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist