Provider Demographics
NPI:1265068464
Name:SOMODY, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SOMODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 493
Mailing Address - Street 2:
Mailing Address - City:LEWISPORT
Mailing Address - State:KY
Mailing Address - Zip Code:42351-0493
Mailing Address - Country:US
Mailing Address - Phone:270-925-5729
Mailing Address - Fax:
Practice Address - Street 1:1915 W PARRISH AVE STE 400
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3519
Practice Address - Country:US
Practice Address - Phone:270-683-2609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100462237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist