Provider Demographics
NPI:1962036814
Name:CONNER, TERESA JEAN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:JEAN
Last Name:CONNER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:JEAN
Other - Last Name:CARMEDELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:750 ROYAL PALM CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4229
Mailing Address - Country:US
Mailing Address - Phone:904-955-1935
Mailing Address - Fax:
Practice Address - Street 1:1016 WILLA SPRINGS DR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5214
Practice Address - Country:US
Practice Address - Phone:407-699-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist