Provider Demographics
NPI:1205242831
Name:DALEY, TERESA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DALEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:TYSZKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11460 JACKSON
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6213
Mailing Address - Country:US
Mailing Address - Phone:303-775-5099
Mailing Address - Fax:
Practice Address - Street 1:735 BAKER ST, LONGMONT, CO
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-775-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist