Teresa Craddock-Starr

Individual provider Active NPI Speech-Language Pathologist · Minerva, OH

NPI 1831579986 · NPPES record last updated Jun 4, 2015

Key facts

NPI
1831579986
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
SP.7040 (OH)
Practice address
130 Bonnieview Ave
Minerva, OH 44657-2014
Phone
(330) 868-4011
NPI assigned
Jun 4, 2015
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
SP.7040OHMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP.7040 OH Yes

Addresses

Primary practice location

130 Bonnieview Ave
Minerva, OH 44657-2014

Mailing address

130 Bonnieview Ave
Minerva, OH 44657-2014
Phone (330) 868-4011

Other providers in Minerva, OH

All providers in Minerva, OH · Speech-Language Pathologist in Ohio

Sources for this page

Verify at the official NPI Registry.