Provider Demographics
NPI:1942513890
Name:TEETER, BREANNE LOUISE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BREANNE
Middle Name:LOUISE
Last Name:TEETER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:BREANNE
Other - Middle Name:LOUISE
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:OCM BOCES
Mailing Address - Street 2:1710 NYA ROUTE 13
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-9648
Mailing Address - Country:US
Mailing Address - Phone:315-868-6738
Mailing Address - Fax:607-758-5245
Practice Address - Street 1:OCM BOCES
Practice Address - Street 2:1710 NYA ROUTE 13
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-9648
Practice Address - Country:US
Practice Address - Phone:315-868-6738
Practice Address - Fax:607-758-5245
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019179-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist