Provider Demographics
NPI:1831235100
Name:MCCOY, THERESE MARIE (SLP)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E GLESSNER ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-4202
Mailing Address - Country:US
Mailing Address - Phone:325-234-5610
Mailing Address - Fax:
Practice Address - Street 1:120 E GLESSNER ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4202
Practice Address - Country:US
Practice Address - Phone:325-234-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17172235Z00000X
GASLP007626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist