Provider Demographics
NPI:1942516034
Name:PRIVETTE, TERI LEE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:LEE
Last Name:PRIVETTE
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MISS
Other - First Name:TERI
Other - Middle Name:LEE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:913 E KNIGHT CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-5331
Mailing Address - Country:US
Mailing Address - Phone:270-827-2055
Mailing Address - Fax:
Practice Address - Street 1:913 E KNIGHT CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-5331
Practice Address - Country:US
Practice Address - Phone:270-827-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3396235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3396OtherKENTUCKY BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
01132967OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION