Provider Demographics
NPI:1457753105
Name:OSTDIEK, TERESA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:OSTDIEK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SAINT PETER ST
Mailing Address - Street 2:APARTMENT 302
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4062
Mailing Address - Country:US
Mailing Address - Phone:308-249-0209
Mailing Address - Fax:
Practice Address - Street 1:50 SAINT PETER ST
Practice Address - Street 2:APARTMENT 302
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4062
Practice Address - Country:US
Practice Address - Phone:308-249-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-9381-SL235Z00000X
NE1697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist