Provider Demographics
NPI:1134456973
Name:TERRY, JEAN NICOLE (MS, SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:NICOLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ARCADIA AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2301
Mailing Address - Country:US
Mailing Address - Phone:401-391-7345
Mailing Address - Fax:
Practice Address - Street 1:80 ROY AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-6023
Practice Address - Country:US
Practice Address - Phone:508-399-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00788235Z00000X
MASP 6758 SL235Z00000X
PASL008676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist