Provider Demographics
NPI:1922641281
Name:BARNES, TERESA KAY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:KAY
Last Name:BARNES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:KAY
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:326 PARSLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-1014
Mailing Address - Country:US
Mailing Address - Phone:073-632-2991
Mailing Address - Fax:307-514-6478
Practice Address - Street 1:326 PARSLEY BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-1014
Practice Address - Country:US
Practice Address - Phone:307-632-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist