Provider Demographics
NPI:1023396611
Name:BESSON, TERESA O'DOM (SLP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:O'DOM
Last Name:BESSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:KAREN
Other - Last Name:BERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1015 CINDERELLA CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3205
Mailing Address - Country:US
Mailing Address - Phone:318-481-0835
Mailing Address - Fax:
Practice Address - Street 1:1015 CINDERELLA CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3205
Practice Address - Country:US
Practice Address - Phone:318-481-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist