Provider Demographics
NPI:1245715523
Name:EBERLY, TERRY (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:EBERLY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7486 S KENDALL BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4682
Mailing Address - Country:US
Mailing Address - Phone:303-916-3550
Mailing Address - Fax:
Practice Address - Street 1:26 W DRY CREEK CIR STE 425
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8066
Practice Address - Country:US
Practice Address - Phone:303-794-4900
Practice Address - Fax:303-794-4999
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist