Provider Demographics
NPI:1396499885
Name:PETRUCCI-COLEY, TERESA (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PETRUCCI-COLEY
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1601
Mailing Address - Country:US
Mailing Address - Phone:713-201-7926
Mailing Address - Fax:
Practice Address - Street 1:2929 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1534
Practice Address - Country:US
Practice Address - Phone:713-592-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist